Pneumatic Balloon Dilation for The Treatment Of Post-Fundoplication Symptoms: Long-Term Efficacy and Safety Results

Aims Post-laparoscopic fundoplication (LF) dysphagia occurs in 5 %-17 % of patients and its optimal management remains questionable. We assessed the safety and efficacy of pneumatic dilation (PD) in patients with post-LF symptoms.

Methods Medical files of all patients treated with at least one PD for post-fundoplication-associated symptoms were reviewed. Demographic, clinical, radiological and endoscopic data were collected. Long-term clinical success was the primary outcome, while PD-related complication incidence comprised the secondary endpoint.

Results From 2006 to 2019, 50 patients [76 % women, 58.5±11.8 years, median follow-up 665 (304-1566) days] underwent 79 PD (mean: 1.58±0.84) with dysphagia being the most common symptom [78 %; mean Eckardt score 4.84±1.88), followed by pain (10 %) and vomiting (6 %). A 30mm, 35mm and 40mm balloon was used in 45.6 %, 43 % and 11.4 % of the dilations, respectively. Among 49 patients with available follow-up, 39 (79.6 %; 95 %CI 65.2-89.3) had an initial clinical response, while symptoms recurred in 9 patients (23.1 %; 95 %CI 11.7-39.7) and 4 of them were effectively treated by a new dilation. Thus, the overall long-term success rate of PD was 34/49 (69.4 %; 54.4-81.3). Among 15 non-responders to PD, 12 underwent surgery (24.5 % 95 %CI 13.8-39.2; Nissen redo 58 %). Overall, 4 complications (2 perforations, 1 muscularis dilaceration and 1 severe bleeding) occurred in 4 patients [incidence: 5.1 % (95 %CI; 2-12.3)]. The first perforation occurred at the level of the plicature (PD at 30mm), the second at the lower esophagus (PD at 40mm), while dilaceration occurred also at the lower esophagus after a PD at 35mm. An intrathoracic slipping of the Nissen was absent in all three cases. They were effectively treated with self-expandable metallic esophageal stents. Significant bleeding followed a PD at 35mm and was ceased using hemostatic clips.

Conclusions Pneumatic balloon dilation for post-fundoplication-associated symptoms is associated with satisfactory long-term success rate and acceptable safety profile.

Citation: Gkolfakis P, Lorenzo D, Blero D et al. eP14 PNEUMATIC BALLOON DILATION FOR THE TREATMENT OF POST-FUNDOPLICATION SYMPTOMS: LONG-TERM EFFICACY AND SAFETY RESULTS. Endoscopy 2021; 53: S101.

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Artikel online veröffentlicht:
19. März 2021