Chan K C, Wong S K H, Lee D W H, Mui W L M, Chan A C W, Ng E K W, Wu J C Y, Sung J J Y, Chung S C S
Dept. of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
Endoscopy. 2004 Aug;36(8):690-4. doi: 10.1055/s-2004-825659.
This retrospective study reports 12 years' experience with pneumatic dilation treatment in patients with achalasia and attempts to define factors capable of predicting failure of endoscopic dilation.
Consecutive patients with achalasia who received endoscopic balloon dilation were studied retrospectively. Repeat dilation was carried out if dysphagia persisted or recurred. A structured symptom score questionnaire (the Eckardt score) was conducted by phone with patients who had received dilation and had been followed up for more than 2 years. Failure was defined as the presence of significant dysphagic symptoms after more than two repeat dilations. Data for the first 2 years (short-term) and for the subsequent follow-up (long-term) were analyzed.
From 1989 to 2001, 66 patients underwent endoscopic balloon dilation for achalasia; three perforations (4.5 %) occurred, with no mortalities. Dysphagic symptoms significantly improved 12 weeks after the procedure ( P < 0.05). Fourteen patients (20 %) required a second dilation procedure within a median of 7 months (range 1 - 52 months), and 13 of them underwent repeat dilations within the first 2 years. Five patients (7.5 %) required further surgical or endoscopic therapy. Fifty-eight patients received pneumatic dilation for more than 2 years; 32 (55 %) responded to the questionnaire. The mean dysphagia score was 1.7 (SD 1.2), with only five patients (16 %) having significant dysphagic symptoms during a median follow-up period of 55 months (range 26 - 130 months). The cumulative success rates for pneumatic dilation after 5 and 19 years were 74 % and 62 %, respectively. Cox regression analysis identified small balloon size (30 mm) as the only significant factor capable of predicting failure of endoscopic dilation ( P = 0.009; relative risk 5.3; 95 % confidence interval, 1.7 to 40.9).
Endoscopic balloon dilation is an effective treatment for achalasia, with minimal morbidity (60 % experience long-term benefit).
本回顾性研究报告了12年来对贲门失弛缓症患者进行气囊扩张治疗的经验，并试图确定能够预测内镜下扩张失败的因素。
对连续接受内镜下气囊扩张治疗的贲门失弛缓症患者进行回顾性研究。如果吞咽困难持续或复发，则进行再次扩张。通过电话对接受扩张并随访超过2年的患者进行结构化症状评分问卷调查（埃卡德特评分）。失败定义为在两次以上重复扩张后仍存在明显的吞咽困难症状。分析了前2年（短期）和随后随访（长期）的数据。
1989年至2001年，66例患者接受了内镜下气囊扩张治疗贲门失弛缓症；发生3例穿孔（4.5%），无死亡病例。术后12周吞咽困难症状明显改善（P<0.05）。14例患者（20%）在中位时间7个月（范围1 - 52个月）内需要进行第二次扩张手术，其中13例在最初2年内接受了重复扩张。5例患者（7.5%）需要进一步的手术或内镜治疗。58例患者接受气囊扩张治疗超过2年；32例（55%）回复了问卷。平均吞咽困难评分为1.7（标准差1.2），在中位随访期55个月（范围26 - 130个月）内，只有5例患者（16%）有明显的吞咽困难症状。5年和19年后气囊扩张的累积成功率分别为74%和62%。Cox回归分析确定小气囊尺寸（30 mm）是唯一能够预测内镜下扩张失败的显著因素（P = 0.009；相对风险5.3；95%置信区间，1.7至40.9）。
内镜下气囊扩张是治疗贲门失弛缓症的有效方法，发病率极低（60%的患者有长期获益）。
