The kinetic changes in esophageal achalasia treated by pneumatic dilation or intra-sphincteric injection of botulinum toxin / 中华消化内镜杂志

ABSTRACT

Objective To compare the effects of intrasphincteric injection of botulinum toxin or pneumatic dilation on the treatment of achalasia. Methods One hundred and eighteen patients with esopha-geal achalasia were randomly assigned into 2 groups. (1) Injection group; botulinum toxin 100iu was injected into the muscular layer around LES under endoscopies with each site 20iu. (2) Dilation group; Dilating the cardiac sphincter with Rigiflex dilation balloon under endoscopies. Esophageal manometry was performed before and one week after treatment. And clinical symptoms were observed. Results Before therapy the 3 kinetic parameters of both groups revealed no significant statistical difference, but after therapy in dilation group LESP decreased to (6.03?3.45) mm Hg, LESRP ( -0. 11 ?2. 34) mm Hg, LESRR increased to 92. 50% ? 13. 86% , with significant statistical difference as compared to the data before treatment. In injection group LESP decreased to (23. 16 ? 16. 17) mm Hg, LESRP and LESRR after therapy showed no statistical difference as compared to the corresponding data before therapy. The improvement of clinical symptoms in dilatation and injection groups graded as prominent effective, improved and failed were 45 ( 80. 36% ) , 11 (19.64% ) ,0 and 15(24.19% ) , 38(61.29% ) , 9( 14.52% ) respectively. Conclusion In the treatment of esophageal achalasia the short term effect of pneumatic dilatation is superior to intrasphincteric injection method, the improvement of clinical symptoms is closely related to the decrease of LESP and LESRP especially the later.