Endoscopic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up

Background: Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up. Methods: We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. 216 patients did not undergo PBD due to comorbid diseases. Ultimately, 1092 achalasia patients were enrolled. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Response to treatment was evaluated by Vantrappen scoring system. Results: Of 1092 achalasia patients, 937 patients were treated by PBD and 155 patients were treated by combined therapy (PBD 1 month after Botulinum toxin injection). In short-term follow-up, 728 of 1092 patients underwent one PBD and 77.3% of them had excellent or good response (responders), 163 patients (58.6%) who underwent two PBDs were responders, and 44 (51.2%) patients who underwent three PBDs were responders. Overall, 2193 balloon dilations were performed on 1092 patients (mean 2 PBDs/patient). Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. The responders with two, three, and four or more dilations were 149, 67, and 67, respectively. The overall response rate was 69%. No any serious complications were noted by using the graded gradual method. Conclusion: Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.

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Predictive factors in early arthritis: long-term follow-up

Seminars in Arthritis and Rheumatism ◽

10.1053/s0049-0172(03)00130-6 ◽

2004 ◽

Vol 33 (4) ◽

pp. 264-272 ◽

Cited By ~ 22

Author(s):

H Schumacher

Keyword(s):

Predictive Factors ◽

Early Arthritis ◽

Long Term Follow Up

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Total Ossiculoplasty in ChildrenPredictive Factors and Long-term Follow-up

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archoto.2011.204 ◽

2011 ◽

Vol 137 (12) ◽

pp. 1240 ◽

Cited By ~ 17

Author(s):

Jerome Nevoux

Keyword(s):

Predictive Factors ◽

Long Term Follow Up

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Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2011.02.008 ◽

2011 ◽

Vol 157 (1) ◽

pp. 78-83 ◽

Cited By ~ 24

Author(s):

Maria Elisabetta Coccia ◽

Francesca Rizzello ◽

Antonio Palagiano ◽

Gianfranco Scarselli

Keyword(s):

Multivariate Analysis ◽

Predictive Factors ◽

Laparoscopic Treatment ◽

Long Term Follow Up

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Arterial morbidity following interventional balloon dilation procedures

Cardiology in the Young ◽

10.1017/s1047951100003255 ◽

1996 ◽

Vol 6 (1) ◽

pp. 54-58 ◽

Cited By ~ 3

Author(s):

Amanda Barlow ◽

Samuel Menahem ◽

James L. Wilkinson

Keyword(s):

Balloon Dilation ◽

Arterial Circulation ◽

Arterial Complications ◽

Operator Type ◽

Low Weight ◽

Long Term Follow Up ◽

Interventional Catheterization ◽

Arterial Damage

SummaryInterventional catheterization procedures performed via the arterial route are well recognized therapies which are being employed with increasing frequency. This review summarizes our experience with local arterial complications of such procedures performed on 44 patients in our institution since 1985. A total of 51 balloon dilations were performed. All patients were heparinized during the procedure. Twenty-one procedures (41%) were followed by clinical evidence of reduced arterial circulation to the affected leg more than four hours after the procedure. Continuing infusion of heparin was used in 17 patients, with return of the pulse concerned in six, while two further patients developed evidence of arterial obstruction after an interval (having initially been found to have ‘satisfactory’ pulses at the end of the procedure). The final infant, whose femoral artery had been torn and could not be repaired, was observed without continuing heparinization. Streptokinase and/or tissue plasminogen activator was employed in eight patients, with resultant success in four. The remaining three, and three who failed thrombolytic therapy, underwent embolectomy. The incidence of arterial damage was related to the size of the catheter (assessed by the size of sheath required to introduce the collapsed balloon, indexed to body surface area) and to low weight or young age at the time of the procedure. No relationship could be established with other variables, including operator, type of catheter, or year or duration of procedure. At long-term follow-up, 11 (22%) patients still have absent or reduced pulses in the leg concerned. Arterial damage following interventional catheterization procedures remains a frequent occurrence despite increasing experience and technical improvements.

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