Efficacy of pneumatic dilatation as a definitive therapeutic modality for classic achalasia

ObjectiveTo evaluate pneumatic dilatation (PD) for cases of cardiac achalasia as a first-line therapy.Patients and methodsThe study included 35 patients. All patients were assessed for disease severity using Valiukenas Achalasia Severity (VAS) scoring system and the disease was staged using Kostic esophageal dilatation (KED) staging system. Patients underwent manometric esophageal pressure (MEP) measurement. All patients underwent PD. Patients were followed up for 12-months, failure of symptomatic relief or recurrence of symptoms was followed by another PD attempt or laparoscopic Heller’s myotomy combined with Dor fundoplication and follow-up for another 12 months.ResultsTwenty-seven patients took their 1st oral intake after 9–12 h and 25 patients (71.5%) were managed as one-day procedure. At 12-M follow-up, three patients (8.5%) required three attempts of PD, five patients (14.3%) required two attempts and 27 patients had only one attempt to achieve relief of symptoms. At the end of 12-M follow-up period; 26 patients showed sustained complete relief of symptoms and scored zero on VAS scoring and had stage I on KED staging. For these 26 the subjective and objective success rate was 74.4%. Nine patients who had failed PD trials were planned for surgery. Subjective surgical success rate was 66.7% and objective success rate was 77.8%. Comparison of outcome of both modalities showed nonsignificant subjective improvement in favor of PD, while surgery showed non-significant objective improvement compared to PD.ConclusionPD could be considered as safe, effective and cost-effective therapeutic modality for patients having classic achalasia with high subjective and objective success rate.