Ten-year Outcome in Achalasia : Prospective Study of Surgical Myotomy and Pneumatic Dilatation

Pakkavuth Chanswangphuvana, MD, Soravith Vijitpornkul, MD, Ajjana Techagumpuch, MD, Suppa-ut Pungpapong, MD, Suthep Udomsawaengsup, MD, Patpong Navicharern, MD, Chadin Tharavej. Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Introduction
Less was known regarding the effectiveness of surgical myotomy and pneumatic dilatation in the treatment of achalasia. This study aimed to compare the treatment outcome of surgical myotomy and pneumatic dilatation.

Methods
Medical records of 85 patients diagnosed as achalasia (2002-2012) were reviewed. Only patients underwent surgical myotomy or pneumatic dilatation were included. Patients who lost to follow up or had treatment other than surgical myotomy or pneumatic dilatation were excluded from the study. Standardized questionnaire of 4 symptoms were prospectively collected before and after treatment (August, 2013). These symptoms included dysphagia, regurgitation, chest pain and weight loss. Each symptom was scored range from 0 to 3 depending on symptom severity. Patients who had total symptom score more than 2 or underwent second intervention were considered as unfavorable outcome.

Results
There were 46 patients fit to the criteria. 23 patients underwent pneumatic dilatation and 23 patients had surgical myotomy. There was no treatment mortality. Ten-year favorable outcome was 80% for surgical myotomy and 43% for single pneumatic dilatation (p = 0.001). If repeated pneumatic dilatations were not considered as unfavorable outcome in pneumatic dilatation and total symptom scores after last treatment were analysed, ten-year favorable outcome of pneumatic dilatation was comparable to that of surgical myotomy (75% vs 80%, p = 0.51).

Conclusion
Surgical myotomy is more effective than single pneumatic dilatation in term of ten-year outcome for treatment of achalasia. However, if repeated pneumatic dilatations are included, ten-year outcome is comparable to that of surgical myotomy.

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