Aliment Pharmacol Ther 31, 658–665
Summary
Background Long‐term follow‐up studies of achalasia after pneumatic dilation, mostly retrospective, have shown variable results.
Aim To examine the outcome of achalasia after pneumatic dilation using a prospective follow‐up programme.
Methods One or two dilations (first dilation treatment) in 77 patients to achieve stable (>1 year) remission and patients followed up with yearly clinical and manometric assessments. Endoscopy, pH monitoring and barium swallow were also performed.
Results A total of 69 patients achieved stable remission and were followed up for 5.6 years (3–10.7) [median (IQ range)], whereas six patients underwent cardiomyotomy and two experienced a perforation. Twelve of the 69 patients relapsed after 2.6 years (1.7–5.1): nine of 12 underwent one to two further dilations. Six‐year remission rate (by Kaplan–Meyer estimates) was 82% after first dilation treatment and 96% after all dilations. Continuous antisecretory treatment was clinically needed in 16%, oesophagitis present in 7% and reflux pathological in 28% of the patients. Beneficial effects of dilation on oesophageal motility and on diameter of the oesophageal body at barium swallow were maintained during follow‐up.
Conclusions A management strategy including sessions of pneumatic dilation until stable remission and a standardized follow‐up is highly successful in the long term. Gastro‐oesophageal reflux is clinically relevant in a minority of patients.