PREDICTORS OF POOR RESPONSE TO ENDOSCOPIC DILATION DURING ACHALASIA

Aims The purpose of this work is to identify predictive factors for poor response to endoscopic dilatation during achalasia.

Methods This is a retrospective study between January 2009 and March 2019, including all patients with achalasia whose diagnosis was retained on a set of clinical arguments, endoscopic, manometric. Endoscopic dilatation was performed with pneumatic balloons. The effectiveness of the treatment was judged on the Eckart Score. The poor response to dilation was defined by the lack of improvement after a maximum of 5 dilations

Results During the study period, 178 patients were collected for achalasia. The average age was 46 ± 14.5 years old. The sex ratio (H/F) was 1.17. The main symptom was dysphagia in 100% followed by regurgitation in 56.4% (N 97) and weight loss in 54.5% (N 94). The average Eckart score before treatment was 6.7 ± 1.2. Endoscopy was performed in all patients and showed salivary and food stasis in 68.6%. Standard manometry was performed in 84.9% and showed hyperkinesia of the proximal and distal esophagus in 16.2%, a high rest pressure of the lower sphincter of the esophagus in 73.3%. Endoscopic balloon dilatation was proposed in 97.6% while the peroral endoscopic myotomy (POEM) was performed in 2.3% (N = 4). The average number of dilations was 1.62 ± 0.9. Eckart score after treatment was 2.4 ± 1.8. The poor response to dilatation was objectified in 16.8% (N = 28) including 11 patients who have been operated on. Predictors of poor response to endoscopic dilatation were age ≤ 35 years (p < 0.001, OR = 13), gender (p = 0.04, OR = 0.4), esophageal hyperkinesia (p < 0.001 OR = 0.34).

Conclusions Our work confirme the data from the literature. Thus, the presence of factors of poor response to endoscopic dilatation must be considered in the therapeutic arsenal