Dilatación neumática en el tratamiento de pacientes con acalasia / Pneumatic dilation in the treatment of achalasia

INTRODUCCIÓN: La dilatación neumática y la miotomía quirúrgica son actualmente los tratamientos de elección de la acalasia sintomática. La selección de una u otra como primera opción depende de la experiencia de cada centro y de las preferencias del paciente. OBJETIVO: Revisar la experiencia en nuestro centro de la dilatación neumática en pacientes con acalasia. MATERIAL Y MÉTODOS: Se incluyeron todos los pacientes con diagnóstico clínico, endoscópico y manométrico compatible con acalasia a los que se les practicó una dilatación neumática en un periodo de 19 años. Todas las dilataciones se realizaron de forma sistemática con un balón Rigiflex(R), en la mayoría de los casos con presiones de 250, 250 y 300 mmHg en 3 tiempos de un minuto separados por un minuto de duración. Se evaluó el éxito de la dilatación en función de la sintomatología del paciente, número de sesiones requeridas y necesidad de cirugía, así como la presencia de complicaciones. RESULTADOS: Se incluyeron 171 pacientes, 53,2% varones y 46,8% mujeres, con una edad media de 51,53 ± 17,78 años (16-87), desde junio de 1993 hasta octubre de 2012. En 157 pacientes se utilizó un balón de 35mm, en 9 pacientes un balón de 30 mm y en 7 pacientes, uno de 40 mm. Del total de pacientes: 108 requirieron una sola sesión de dilatación, 56 dos sesiones con un tiempo medio entre la primera y la segunda sesión de 25,23 ± 43,25 meses (1-215) y 7 pacientes, 3 sesiones con un tiempo medio entre la segunda y la tercera sesión de 6,86 ± 5,33 meses (1-15). El 82% de los pacientes presentaron una buena evolución tras la dilatación, considerándose esta exitosa. De los 140 pacientes que presentaron respuesta, 121 tuvieron respuesta completa (desaparición total de los síntomas sin reaparición de los mismos) y 19 respuesta parcial (desaparición inicial de los síntomas con posterior reaparición). Un 15,8% de los pacientes requirieron cirugía (miotomía de Heller). En 4 de los 171 pacientes hubo complicación de la técnica, siendo todas ellas perforaciones que se resolvieron satisfactoriamente, 2 de ellas con tratamiento conservador y otras 2 de forma quirúrgica. No hubo ningún evento de mortalidad en relación con la técnica ni con las complicaciones de la misma. CONCLUSIONES: En nuestra serie, la dilatación neumática presentó una alta tasa de éxito, en la mayoría de los casos con una única sesión, y un escaso porcentaje de complicaciones, por lo que demuestra ser una técnica eficaz y segura para estos pacientes, evitando un gran número de intervenciones quirúrgicas

INTRODUCTION: Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences. Background and aims: To review the experience of pneumatic dilation in patients with achalasia in our center. MATERIAL AND METHODS: We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex(R) balloon, usually at pressures of 250, 250 and 300mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications. RESULTS: A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53 ± 17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23 ± 43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86±5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications. CONCLUSIONS: In our series, pneumatic dilation had a high success rate. In most patients, a single session was required and the complications rate was low. These results show that this technique is safe and effective in these patients, avoiding a large number of surgical interventions

[Pneumatic dilation in the treatment of achalasia]. / Dilatación neumática en el tratamiento de pacientes con acalasia.

INTRODUCTION: Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences. BACKGROUND AND AIMS: To review the experience of pneumatic dilation in patients with achalasia in our center. MATERIAL AND METHODS: We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex(®) balloon, usually at pressures of 250, 250 and 300mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications. RESULTS: A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53±17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23±43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86±5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications. CONCLUSIONS: In our series, pneumatic dilation had a high success rate. In most patients, a single session was required and the complications rate was low. These results show that this technique is safe and effective in these patients, avoiding a large number of surgical interventions.