Clinical Study On Simple Pneumatic Dilation And Combined Therapy Of Both Pneumatic Dilation And Botulinum Toxin Injection In Patients With Esophageal Achalasia

AimTo explore the efficacy and side-effects of simple pneumatic dilation and combination of both pneumatic dilation and intrasphincteric injection botulinum toxin-A in the management of esophageal achalasia.Patients and methodsGathering up 127 inpatients with esophageal achalasia from 1999.1 to 2009.12 in Department of Gastroenterology, Shandong Provincial Hospital, all patients were diagnosed by clinical symptoms, barium esophagogram, edoscopy or esophageal manometry. Of these inpatients,61 patients underwent simple pneumatic dilation, and other 66 ones underwent the combination modality; all of the 127 inpatients had dysphagia with different degrees, which were graded by Stooler grading method, and the efficacy of therapy was evaluated by the relieving of dysphagia. Study the relevant case histories before treatment,3 days,1 year,3years and 5 years after treatment by telephone follow-up, to understand the immediate and long-term efficacy of the two modalities.ResultBoth simple pneumatic dilation and the combination treatment could relieve the clinical symptoms, their immediate efficiency was 100%.3 days after treatment, LESP and LESRR of both groups were decreased obviously compared to those before treatment, and the decreasement of LESP of both groups was in no significant difference. Of 127 cases,71 patients were in telephone follow-up, while other 56 cases were lost; Of the 71 patients,40 patients underwent pneumatic dilation, with 21 cases treated more than 1 year, total effective rate 81.0%, markedly effective rate 57.1%,11 cases more than 3 years, total effective rate 54.5%, markedly effective rate 36.4%, and 5 cases more than 5 years, total effective rate 40%, markedly effective rate 20%; Other 31 cases underwent the combination of both pneumatic dilation and intrasphincteric injection botulinum toxin-A, with 22 cases treated more than 1 year, total effective rate 86.4%, markedly effective rate 59.1%,15 cases more than 3 years, the total effective rate 66.7%, markedly effective rate 40%, and 6 cases more than 5 years, total effective rate 50%, markedly effective rate 33.3%.ConclusionsBoth simple dilation and combination treatment could relieve the clinical symptoms. The combination of both pneumatic dilation and intrasphincteric injection botulinum toxin-A in the management of esophageal achalasia had a good long-term efficacy, without increasing the sufferings of patients and the danger of esophageal perforation and upper digestive tract bleeding.