OUTCOME OF ENDOSCOPIC THERAPEUTIC INTERVENTIONS: ARE THEY DIFFERENT AMONG VARIOUS NON- MALIGNANT ESOPHAGEAL DISEASES
Abstract
Background: This study was carried out to evaluate and compare the outcome of various causesof non-malignant lesions of the esophagus after endoscopic therapeutic intervention. Methods: Acohort of patients with non-malignant dysphagia presenting at Aga Khan University hospital, atertiary care setting who underwent endoscopic intervention was studied. Response to treatmentwas evaluated by improvement in dysphagia score on a scale of 0-4 and weight gain. Results: 99subjects (53 males) were included. Mean age was 48.6±17.2 years. Dysphagia for solids waspresent in 48%, for liquids in 3% and for both in 49% patients. Significant weight loss (>10%body weight) occurred in 35 (35.3%) patients. Achalasia was diagnosed in 49.5%, peptic stricturein 30.4%, post sclerotherapy stricture in 12.1%, corrosive injury in 4%, post-operative stricture in4%. In comparative analysis of achalasia and inflammatory groups, good response to dysphagiawas seen in 40/49 (82%) and 22/50 (44%) respectively p < 0.001. Weight gain was 35/49 (72%)and 22/50 (44%) p <0.001 respectively. Significantly, more endoscopic sessions were required ininflammatory group compare to achalasia; 2.2 and 1.1 respectively; p <0.001 and 16%complications rate in inflammatory group comparing to no complications in achalasia.Conclusions: Dysphagia and weight loss were common presentations in non-malignantesophageal diseases. Therapeutic intervention in inflammatory group was associated with highcomplication than the achalasia group.Key words: outcome of non-malignant esophageal diseases, Benign esophageal lesions,Achalasia, esophageal strictures.References
Katz PO, Gilbert J, Castell DO. Pneumatic dilatation is
effective long- term treatment for achalasia. Dig Dis Sci 1998;
(9):1973-77
J Ayub Med Coll Abbottabad 2005;17(4)
Yeming W, Somme S, Chenren S, Huiming J, Ming Z.
Balloon catheter dilatation in children with congenital and
acquired esophageal anomalies. J Paeds Surg 2000;37(3)398-
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcomes
in patients with achalasia treated by pneumatic dilatation.
Gastroenterology 1992;103:1732-8.
Vantrappen G. Hellemans J, Deloof W, Valembois P,
Vandenbroucke J. Treatment of achalasia with pneumatic
dilations. Gut 1971;12:268-75.
Kim HC, Cameron AJ, Hsu JJ, Talley NJ, Trastek VF,
Pairolero PC et al. Achalasia: Prospective evaluation of
relationship between lower esophageal sphincter pressure,
esophageal transit and esophageal diameter and symptoms in
response to pneumatic dilatation. Mayo Clin Proc
;68:1067-73.
Cocia G, Bortolotti M, Michetti P, Dodero M. Prospective
clinical and manometric study comparing pneumatic dilation
and sublingual nifedipine in the treatment of oesophageal
achalasia. Gut 1991;32:604-6.
Spiess AE, Kahrilas PJ. Treating Achalasia from whalebone to
laparoscope. JAMA 1998;280(7)638-42.
Sabharwal T, Cowling M, Dussek J, Owen W, Adam A.
Balloon Dilation for Achalasia of the Cardia: Experience in 76
patients Radiology 2002; 719-24.
Parkman HP, Reynolds JC, Ouyang A, Rosato EF, Eisenberg
JM, Cohen S. Pneumatic dilatation or esophagomyotomy
treatment for idiopathic achalasia: Clinical outcomes and cost
analysis. Dig Sci 1993;38:75-85.
Csendes A, Braghetto I, Henriquez A, Cortes C. Late results of
a prospective randomized study comparing forceful dilatation
and oesophagomyotomy in patients with achalasia. Gut
;30(3):299-304.
Abid S, Champion G, Richter JE, McElvein R, Slaughter RL,
Koehler RE. Treatment of achalasia: the best of both worlds.
Am J Gastroenterol 1994;89(7): 979-85.
Hussain SZ, Thomas R, Tolia V. A review of achalasia in 33
Children. Dig Dis Sci 2002;47(11)2538-43.
Reynold JC, Parkman HP. Achalasia. Gastroenterol clin North
Am 1989;18:223-55.
London RL, Trotman BW, Di Marino AJ. Dilatation of severe
esophageal strictures by an inflatable balloon catheter.
Gastroenterology 1981;80:173-5.
Johnson A, Jensen LI, Mauritzen K. Balloon-dilation of
esophageal strictures in children. Pediatr Radiol 1986;16:388-
Braghetto I, Csendes A, Burdiles P, Korn O, Compan A,
Guerra JF. Barrett’s Esophagus Complicated with Stricture:
Correlation between Classification and the results of the
Different therapeutic Options. World J Surg 2002;26:1228-33.
Csendes A, Braghetto I. Peptic ulcer of the esophagus
secondary to reflux esophagitis. Gullet 1991;1:177-84.
Zaninotto G, DeMeester T, Bremner C. Esophageal function in
patients with reflux induced strictures and its relevance to
surgical treatment. Ann Thorac Surg 1989;47:362-70.
Barkum AN, Mayrand S. The treatment of peptic esophageal
stricture. Can J Gastroenterol 1997;11(Suppl B): 94-7
Bischof G, Feil W, Riegler M. Peptic esophageal stricture: is
surgery still necessary? Wien Klin Wochenschr 1996;108:267-
Agnew SR, Pandya SP, Reynolds RP. Predictors for frequent
esophageal dilatations of benign peptic strictures. Dig Dis Sci
; 41: 931-6
Song HY, Han YM, Kim HN, Kim CS, Choi KC. Corrosive
esophageal stricture safety and effectiveness of balloon
dilation. Radiology 1992;184:373-8.
Kim IO, Yeon KM, Kim WS, Park KW, Kim JH, Han MC.
Perforation complicating balloon dilation of esophageal
strictures in infants and children. Radiology 1993;189:741-4.
Pereira-Lima JC, Ramires RP, Zamin I, Cassal AP, Marroni
CA, Mattos AA. Endoscopic dilation of Benign Esophageal
Strictures: Report on 1043 Procedures. Am J Gastroenterol
;94(6):1497-01.
