Long-term Efficacy of Modified Retrievable Stents for Treatment of Achalasia Cardia

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2016 Apr 10

PMID 27059970

Citations 2

Authors

Jun Dai

Yufeng Shen

Xiaobo Li

Yunjie Gao

Yan Song

Zhizheng Ge

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate the efficacy, safety and optimal duration of placement of modified retrievable metal stents for treatment of achalasia cardia.

Methods: Patients were randomly divided into groups A (N = 26, modified stents for 3 days), B (N = 26, modified stents for 2 days), C (N = 24, balloon dilation), and D (N = 25, regular stents for 2 days). Clinical symptom scores were recorded at baseline, 6 months, and during long-term follow-up.

Results: Seventy-seven patients with achalasia underwent stent placement (100 % success rate of implantation and extraction, no perforation). No stent migration or drop-off occurred in groups A and B. In group D, stent drop-off and migration was observed in 2 and 1 patients, respectively. Two patients in group C sustained esophageal perforation. Patients in the modified stent (A and B), balloon dilated (C) and regular stents (D) groups experienced significant improvement in dysphagia at 6 months, with recurrence in 1.92, 8.33 and 28 %, respectively. The clinical symptom score in the modified stent groups was significantly lower than that in the balloon dilated group (P = 0.01). During long-term follow-up, the symptom scores in modified stent groups were significantly lower than that in the balloon dilated (P < 0.01) and regular stent (P < 0.01) groups.

Conclusion: Modified retrievable metal stents required an optimal placement duration of 2 days were safe with no incidence of migration or drop-off and had a lower recurrence of symptoms.

Citing Articles

Evaluating the Non-conventional Achalasia Treatment Modalities.

Tustumi F Front Med (Lausanne). 2022; 9:941464.

PMID: 35814742 PMC: 9263126. DOI: 10.3389/fmed.2022.941464.

Achalasia: treatment, current status and future advances.

Swanstrom L Korean J Intern Med. 2019; 34(6):1173-1180.

PMID: 30866609 PMC: 6823561. DOI: 10.3904/kjim.2018.439.

References

Werner Y, Costamagna G, Swanstrom L, von Renteln D, Familiari P, Sharata A . Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut. 2015; 65(6):899-906. DOI: 10.1136/gutjnl-2014-308649. View

von Renteln D, Fuchs K, Fockens P, Bauerfeind P, Vassiliou M, Werner Y . Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013; 145(2):309-11.e1-3. DOI: 10.1053/j.gastro.2013.04.057. View

Zhao J, Li Y, Cheng Y, Li M, Chen N, Chen W . Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience. Eur Radiol. 2009; 19(8):1973-80. PMC: 2705705. DOI: 10.1007/s00330-009-1373-y. View

Verlaan T, Rohof W, Bredenoord A, Eberl S, Rosch T, Fockens P . Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc. 2013; 78(1):39-44. DOI: 10.1016/j.gie.2013.01.006. View

Campos G, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F . Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2008; 249(1):45-57. DOI: 10.1097/SLA.0b013e31818e43ab. View

Yaghoobi M, Mikaeli J, Montazeri G, Nouri N, Sohrabi M, Malekzadeh R . Correlation between clinical severity score and the lower esophageal sphincter relaxation pressure in idiopathic achalasia. Am J Gastroenterol. 2003; 98(2):278-83. DOI: 10.1111/j.1572-0241.2003.07266.x. View

Wang L, Li Y, Li L . Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci. 2008; 54(11):2303-11. DOI: 10.1007/s10620-008-0637-8. View

Vaezi M, Richter J . Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol. 1999; 94(12):3406-12. DOI: 10.1111/j.1572-0241.1999.01639.x. View

Wang L, Li Y, Li L, Yu C . A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol. 2008; 14(38):5900-6. PMC: 2751902. DOI: 10.3748/wjg.14.5900. View

10.

Cai X, Dai Y, Wan X, Zeng Y, Liu F, Wang D . Comparison between botulinum injection and removable covered self-expanding metal stents for the treatment of achalasia. Dig Dis Sci. 2013; 58(7):1960-6. DOI: 10.1007/s10620-013-2564-6. View

11.

Francis D, Katzka D . Achalasia: update on the disease and its treatment. Gastroenterology. 2010; 139(2):369-74. DOI: 10.1053/j.gastro.2010.06.024. View

12.

Sioulas A, Malli C, Dimitriadis G, Triantafyllou K . Self-expandable metal stents for achalasia: Thinking out of the box!. World J Gastrointest Endosc. 2015; 7(1):45-52. PMC: 4295180. DOI: 10.4253/wjge.v7.i1.45. View

13.

Vela M, Richter J, Khandwala F, Blackstone E, Wachsberger D, Baker M . The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006; 4(5):580-7. DOI: 10.1016/s1542-3565(05)00986-9. View

14.

Cheng Y, Ma F, Li Y, Chen N, Chen W, Zhao J . Temporary self-expanding metallic stents for achalasia: a prospective study with a long-term follow-up. World J Gastroenterol. 2010; 16(40):5111-7. PMC: 2965289. DOI: 10.3748/wjg.v16.i40.5111. View

15.

Friedel D, Modayil R, Iqbal S, Grendell J, Stavropoulos S . Per-oral endoscopic myotomy for achalasia: An American perspective. World J Gastrointest Endosc. 2013; 5(9):420-7. PMC: 3773853. DOI: 10.4253/wjge.v5.i9.420. View

16.

Jones E, Meara M, Pittman M, Hazey J, Perry K . Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia. Surg Endosc. 2015; 30(4):1282-6. DOI: 10.1007/s00464-015-4339-y. View

17.

Eckardt V . Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am. 2001; 11(2):281-92, vi. View

18.

Hulselmans M, Vanuytsel T, Degreef T, Sifrim D, Coosemans W, Lerut T . Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol. 2009; 8(1):30-5. DOI: 10.1016/j.cgh.2009.09.020. View

19.

Diaz Roca A, Blanco Sampascual S, Calderon A, Menendez F, Varela J, Baranda A . Self-expanding esophageal prostheses as an alternative temporary treatment for achalasia. Gastrointest Endosc. 2009; 69(4):980. DOI: 10.1016/j.gie.2008.07.019. View