Is pneumatic dilatation still needed for the treatment of achalasia? - 02/05/26
, Chloé Leandri 1, Sophie Scialom 1, Flavius-Stefan Marin 1, 2, Sarra Oumrani 1, Marine Carpentier-Pourquier 1, Arthur Belle 1, Romain Coriat 1, 2, Maximilien Barret 1, 2, 3Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Highlights |
• | What is already known on this subject? Pneumatic dilation is an established treatment for achalasia, with proven short-term efficacy. However, its place in the therapeutic algorithm has been questioned since the advent of POEM, which demonstrates higher short-term success rates but a significantly greater risk of post-procedural gastro-oesophageal reflux. |
• | What are the new findings? In a real-world tertiary centre cohort of 132 treatment-naive achalasia patients, pneumatic dilation achieved a clinical success rate of 76.5% at 40 months median follow-up, with a perforation rate below 1%, among the lowest reported in the literature. |
• | How might it impact on clinical practice in the foreseeable future? Pneumatic dilation remains a valid first-line option for achalasia, particularly in frail or elderly patients, or those concerned about post-POEM reflux, supporting a personalised step-up therapeutic strategy where POEM is reserved for failures. |
Abstract |
Background |
The uncertainty regarding its long-term effectiveness and perforation rates sometimes reaching 4% have led centers to abandon pneumatic dilatation (PD). We evaluated the efficacy and safety of a treatment strategy based on stepwise pneumatic dilations (30, 35 ± 40 mm) in real-world practice among patients with achalasia.
Methods |
This was a retrospective study including consecutive, treatment naive, achalasia patients treated with PD at a single center. The study was based on a prospectively maintained database. The primary endpoint was the rate of clinical remission, defined as an Eckardt score < 3 at the end of follow-up.
Results |
We included 132 patients with achalasia between 2018 and 2023. Achalasia was classified as type I in 44 patients (33%), type II in 83 patients (63%), and type III in 5 patients (4%). Ninety-nine patients (75%) underwent a series of two dilations at 30 and 35 mm, 7 patients (5%) underwent a single 30-mm dilation, and 26 patients (20%) received three dilations at 30, 35, and then 40 mm. The clinical success rate at the first 3-month follow-up was 88%, with no statistically significant difference between subtypes. The median follow-up duration was 40 months. At the end of follow-up, 66 patients (65%) were in clinical remission without additional treatment. Three of the 317 procedures (1%) were complicated by perforation.
Discussion |
Pneumatic dilation provides sustained symptomatic improvement in 65% of patients, with a severe complication rate of 1%. It therefore remains a valuable option to treat achalasia, particularly for frail patients.
Le texte complet de cet article est disponible en PDF.Keywords : Achalasia, pneumatic dilatation, POEM, high resolution manometry
Plan
| No support in the form of grants, equipment, drugs, for all of the above. |
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