PREDICTIVE FACTORS OF OUTCOME OF PNEUMATIC DILATION IN ACHALASIA

Meriam Sabbah*, Dalila Gargouri, Asma Ouakaa, Norsaf Bibani, Dorra Trad, Hela Elloumi and Jamel Kharrat

ABSTRACT

Introduction: Endoscopic balloon dilation (EBD) remains an essential option for treatment of achalasia. Success rate is variable depending on the study. The aim of our study was to identify predictive factors of outcome after endoscopic dilatation for primitive achalasia. Patients and Methods: Retrospective study involving patients with achalasia treated by endoscopic balloon dilatation from January 2002 to January 2016 were included. A follow up period of at least 6 months after EBD was required. Balloon dilatation was performed with Rigiflex® 30 or 35mm balloon. Criteria for failure of EBD were defined by need forrecourse toa second session of dilatation or Heller cardiomyotomy. Results: During the studied period, 120 pneumaticdilationswere performed. 100 patients whose follow-up was available for at least 6 months were included. Sex ratio was 1.12 [M /F =53/47] and average age was 42 +/- 17 years [7-88]. A recurrence of symptoms was observed in 36% of cases after the first session of endoscopic dilatation justifying a second endoscopic dilatation(in 36 cases) or surgical treatment (Heller’s cardiomyotomy) (in 6 cases). The recurrence of symptoms occurred within 5.1 +/- 3 months [1-12 months].Predictors of failure of PD were age <30 years (p =0.01), male gender (p = 0.003), vigorous achalasia (p <0.0001) and an initial PSIO<30mmHg (p=0.01). In multivariate analysis male gender (p<0,001) and vigorous achalasia (p<0,001) were independent predictors of failure of EBD. Conclusion: Independent predictive factors of poor response to endoscopic dilatation in our cohort were clinical (male gender) and manometric (vigorous achalasia). This could suggestto use another technique such as per oral endoscopic myotomy if these factors are present.

Keywords: achalasia, pneumatic dilation, predictive factors.