Pneumatic dilation for achalasia: late results of a prospective follow up investigation
Pneumatic dilation for achalasia: late results of a prospective follow up investigation
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DOI：
10.1136/gut.2003.029298
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发表时间：
2004-05-01
期刊：
影响因子：
24.5
通讯作者：
Bernhard, G
中科院分区：
文献类型：
--
作者：
Eckardt, VF;Gockel, I;Bernhard, G
背景和目的：在这项前瞻性研究中，我们确定了使用brown - mchardy扩张器进行气动扩张治疗的贲门失弛缓症患者的长期临床病程，并确定先前描述的预测结果在长期随访后是否仍然显著。方法：1981 ~ 1991年，连续54例患者行充气扩张术，定期随访，中位随访时间为13.8年。通过使用结构化访谈和先前描述的症状评分来确定缓解。通过Kaplan-Meier估计复发时间来评估缓解持续时间。结果预测因子采用对数秩检验确定。结果：98%的患者随访至2002年。有7名患者死亡，并受到审查。单次充气扩张导致5年缓解率为40%，10年缓解率为36%。反复扩张仅轻度改善临床反应。年龄大于40岁的患者预后明显优于年轻患者（log rank检验，p = 0.0014）。然而，有利的长期预后的最重要预测因素是扩张后食管括约肌压低于10 mm Hg （log rank检验，p = 0.0001）。结论：气压扩张术的长期效果不如以前认为的那样好。年轻患者和那些没有反应的单一气动扩张应提供替代治疗。5年缓解期的患者可能受益于气动扩张术的持久治疗效果。
Background and aims: In this prospective study, we determined the long term clinical course of patients with achalasia who were treated by pneumatic dilation using the Browne-McHardy dilator, and determined whether previously described predictors of outcome remain significant after prolonged follow up.Methods: Between 1981 and 1991, 54 consecutive patients were treated by pneumatic dilation and followed up at regular intervals for a median of 13.8 years. Remission was determined with the use of a structured interview and a previously described symptom score. Duration of remission was evaluated by Kaplan-Meier estimates of time to recurrence. Predictors of outcome were determined using the log rank test.Results: Complete follow up until 2002 was obtained in 98% of all patients. Seven patients had died and were censored. A single pneumatic dilation resulted in a five year remission rate of 40% and a 10 year remission rate of 36%. Repeated dilations only mildly improved the clinical response. Patients who were older than 40 years had a significantly better outcome than younger patients ( log rank test, p = 0.0014). However, the most significant predictive factor for a favourable long term outcome was a post-dilation lower oesophageal sphincter pressure of less than 10 mm Hg (log rank test, p = 0.0001).Conclusions: Long term results of pneumatic dilation are less favourable than previously thought. Young patients and those not responding to a single pneumatic dilation should be offered alternative therapy. Patients who remain in remission for five years are likely to benefit from the longlasting treatment effect of pneumatic dilation.