Dataset Information

Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta-analysis.

ABSTRACT:

Background and aims

One of the most used treatments for achalasia is pneumatic dilation of the lower esophageal sphincter to improve esophageal emptying. Multiple treatment protocols have been described with a varying balloon size, number of dilations, inflation pressure, and duration. We aimed to identify the most efficient and safe treatment protocol.

Methods

We performed a systematic review and meta-analysis of studies on pneumatic dilation in patients with primary achalasia. Clinical remission was defined as an Eckardt score ?3 or adequate symptom reduction measured with a similar validated questionnaire. We compared the clinical remission rates and occurrence of complications between different treatment protocols.

Results

We included 10 studies with 643 patients. After 6 months, dilation with a 30-mm or 35-mm balloon gave comparable mean success rates (81% and 79%, respectively), whereas a series of dilations up to 40 mm had a higher success rate of 90%. Elective additional dilation in patients with insufficient symptom resolution was somewhat more effective than performing a predefined series of dilations: 86% versus 75% after 12 months. Perforations occurred most often during initial dilations, and significantly more often using a 35-mm balloon than a 30-mm balloon (3.2 vs 1.0%); P = 0.027. A subsequent 35-mm dilation was safer than an initial dilation with 35 mm (0.97% vs 9.3% perforations), P = 0.0017.

Conclusions

The most efficient and safe method of dilating achalasia patients is a graded approach starting with a 30-mm dilation, followed by an elective 35-mm dilation and 40 mm when there is insufficient symptom relief.

SUBMITTER: van Hoeij FB

PROVIDER: S-EPMC6849773 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta-analysis.

van Hoeij Froukje B FB Prins Leah I LI Smout André J P M AJPM Bredenoord Arjan J AJ

Neurogastroenterology and motility 20190130 7

<h4>Background and aims</h4>One of the most used treatments for achalasia is pneumatic dilation of the lower esophageal sphincter to improve esophageal emptying. Multiple treatment protocols have been described with a varying balloon size, number of dilations, inflation pressure, and duration. We aimed to identify the most efficient and safe treatment protocol.<h4>Methods</h4>We performed a systematic review and meta-analysis of studies on pneumatic dilation in patients with primary achalasia. C ...[more]

PMID: 30697952

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Dataset Information

Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta-analysis.

Background and aims

Methods

Results

Conclusions

Publications

Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta-analysis.

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