Less was known regarding the effectiveness of surgical myotomy and pneumatic balloon dilatation in the treatment of achalasia particular in laparoscopic era.
This study aimed to compare the treatment outcome of surgical myotomy and pneumatic balloon dilatation.
There were 72 patients diagnosed as achalasia admitted to King Chulalongkorn hospital between 1998-2006. Medical records of these patients were reviewed. All patients were prospectively interviewed by telephone call during April-May, 2007 for 4 standardized symptoms. These symptoms included dysphagia, regurgitation, heartburn and chest pain which were also asked before treatments. Each symptom was scored ranging from 0 to 3 depending on symptom severity. Patients who had total symptom score less than 3 were classified as favorable outcome. Those who had either score more than 2 or underwent second intervention (surgery ,balloon dilatation or other medical treatment) were considered as unfavorable outcome. Patients who lost to follow up or had treatment other than surgical myotomy or pneumatic balloon dilatation were excluded from the study.
There were 45 patients fit to the criteria. The rest of the patients had botox injection, oral nitrate, esophagectomies or lost to follow up. Of these 45 patients, 31 were admitted to Department of Medicine and underwent pneumatic balloon dilatations. Fourteen out of 45 patients were admitted to Department of Surgery and had surgical myotomies. Of 14 patients, 11 underwent successfully laparoscopic myotomies. In pneumatic dilatation group, 9 patients underwent 2 dilatations, 4 had 3 dilatations and 1 had 6 dilatations. One patient in dilatation group underwent surgical myotomy. There was no perforation after dilatations.There was no treatment mortality. Five-year favorable outcome was 78% for surgical myotomy and 56% for pneumatic balloon dilatation (p=0.03). If symptom score of patients with multiple dilatations after last treatment were included for outcome analysis. Five-year favorable outcome of pneumatic dilatation was comparable to that of surgical myotomy (82% vs 78%, p=ns).
Surgical myotomy is more effective than single pneumatic balloon dilatation in the treatment of achalasia. However, if results of multiple dilatations are considered, 5-year favorable outcome of multiple dilatations is comparable to that of surgical myotomy.
Program Number: P251