Comparison of temporary stent insertion with pneumatic dilation of the same diameter in the treatment of achalasia patients: a retrospective study.

ABSTRACT

BACKGROUND AND AIM: To retrospectively analyze and compare the clinical efficacy of temporary stent insertion with pneumatic dilation of the same diameter in the treatment of achalasia based on a long-term follow up. METHODS: A total of 101 treated achalasia patients were divided into a pneumatic dilation group (Group A, n = 38) and a temporary stent insertion group (Group B, n = 63). The diameter of the balloon or stent used was 30 mm. The total symptom scores (TSS) and esophageal manometry were used to assess the symptoms and lower esophageal sphincter (LES) pressure improvement. Barium swallow-esophageal studies were used to assess esophageal emptying objectively. TSS and LES pressure improvement were assessed, recorded, and compared during the regular interval follow up. RESULTS: Forty-nine pneumatic dilations and 65 stent insertions were successfully performed in all patients under fluoroscopy. Complications included pain, reflux, and bleeding, which occurred in nine (23.6%), eight (21.1%), and three (8%) patients in Group A, and in 27 (42.9%), eight (12.7%), and 10 (15.9%) patients in Group B, respectively. The stent was retained approximately 4-7 days and was retrieved via endoscope. TSS, esophageal manometry, and barium esophagram post-treatment significantly improved compared to those given pretreatment (P < 0.0001). At the end of follow up, TSS and LES pressure in Group B were 4.00 +/- 1.00 and 43.67 +/- 12.66 mmHg, compared to 10.20 +/- 0.45 (P = 0.0096) and 58.60 +/- 8.65 mmHg (P = 0.1687) in Group A. The Kaplan-Meier method revealed better symptom remission in Group B compared to Group A (log-rank test, P = 0.0212). CONCLUSION: Retrievable stent placement is more effective than the same diameter pneumatic dilation for the treatment of achalasia with a long-term follow up.