Comparison of endoscopic balloon dilation with surgical therapy in management of esophageal achalasia / 中华消化杂志

ABSTRACT

Objective To compare the effects and safety of endoscopic balloon dilation with surgical therapy in treating esophageal achalasia. Methods The patients who were diagnosed as achalasia of cardia from Jan. 2002 to Dec. 2007 were consecutively collected. All patients were divided into endoscopic balloon dilation group (endoscopy group), thorascopic / laparoseopic surgery group (telescopy group) and standard thoracotomy group (operation group). The efficacy, relapse rate and safety were compared among three groups. Results Ninety eight patients were enrolled. There were 57 patients in endoscopy group, 24 patients in telescopy group, and 17 patients in opreation group. All of the patients completed the treatment. There was one case (1.6%) in endoscopy group complicated with esophageal rupture, two (8.3%) in telescopy group complicated with esophageal fistula, and one (5.9%) in operation group complicated with severe post-operation pneumonia infection, acute respiratory distress syndrome and infectious shock. The rest patients had symptomatic relief of dysphagia in different degrees after therapy, and that was further confirmed by symptoms assessment, x-ray, or endoscopic examination after one month. Five patients (8.9%) in endoscopy group relapsed, with a duration of 5 to 31 months (mean 8 months), and underwent re-dilation or stent placement successfully. One patient (4.2%) in telescopy group relapsed after 6 months and underwent re-dilation successfully. No one relapsed in operation group. Conclusions Compared with standard operation group and telescopy group, endoscopic balloon dilation is deserved to use widely in clinical application with its advantages of simple, convenient and low complication. In spite of its relapse, it still can be remedied well by endoscopic re-dilation or stent placement.