IDDF2022-ABS-0072 Sequential pneumatic dilatation for achalasia cardia: a prospective cohort study. (2nd September 2022)

• Record Type: Journal Article
• Authors: Dhali, Arkadeep; Misra, Debashis; Banerjee, Arka; Das, Kausik; Das, Ksaunish
• Is Part Of: Gut. Volume 71(2022)Supplement 2
• Page Start: A76
• Page End: A77
• Publication Date: 2022-09-02
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-IDDF.95
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Background: Balloon diameter is sequentially increased while performing endoscopic pneumatic dilatation procedures aiming to achieve symptomatic relief for patients with achalasia cardia (AC). The current body of medical literature mostly discusses retrospective studies. This study aims to look into the outcome of the procedure through a prospective cohort study. Methods: This study was conducted in the Department of Gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India. Seventy-two consecutive patients (IDDF2022-ABS-0072 Figure 1. Study design) with AC were subjected to graded pneumatic dilatation with 30, 35, and 40 mm balloons. Post-procedure, they were followed up using the Eckardt score. The proportion of patients who maintained clinical remission (Eckardt score ≤ 3) and didn't require surgical intervention during follow-up (median: 48 weeks, range: 4–96 weeks) were considered for assessing the efficacy of the procedure. Results: Out of the 72 patients, 6 patients were lost to follow-up after the 1st pneumatic dilatation. Hence the outcome was assessed on 66 patients. Sixty (91%) of them remained symptom-free and didn't require any surgical intervention. The number of type 3 achalasia (IDDF2022-ABS-0072 Figure 2. Kaplan Meier curve showing the probability of surgery-free survival over time in three subtypes of achalasia) patients was significantly higher ( p = 0.005) in the group warranting surgery compared to those who did not. Future requirement of surgical intervention in patients with type 3 achalasia (IDDF2022-ABS-0072 Figure 3. Receiver operating characteristic roc curve of 4-week post-dilatation integrated relaxation pressure IRP in predicting requirement of surgery in type 3 achalasia) was predicted from a threshold of 12mm Hg in 4-week post-dilatation integrated relaxation pressure (sensitivity: 75%, specificity: 85%). 2.9% of the patients developed major procedure-related complications and required in-patient management. 1.9% of patients developed perforation. Conclusions: This prospective cohort study shows that clinical remission can be achieved and maintained in patients with achalasia by sequentially increasing the balloon diameter of pneumatic dilatation. This procedure is fairly safe with an acceptable morbidity profile. Major surgical interventions can be avoided in a good number of patients who benefits from the procedure.