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For Patients with Primary Achalasia the Clinical Success of Pneumatic Balloon Dilatation Can Be Predicted from the Residual Fraction of Radionuclide During Esophageal Transit Scintigraphy

Authors
 Han Ho Jeon  ;  Young Hoon Youn  ;  Kwangwon Rhee  ;  Jie-Hyun Kim  ;  Hyojin Park  ;  Jeffrey L. Conklin 
Citation
 DIGESTIVE DISEASES AND SCIENCES, Vol.59(2) : 375-382, 2014 
Journal Title
DIGESTIVE DISEASES AND SCIENCES
ISSN
 0163-2116 
Issue Date
2014
MeSH
Adult ; Age Factors ; Asian Continental Ancestry Group ; Dilatation ; Esophageal Achalasia/diagnostic imaging ; Esophageal Achalasia/epidemiology ; Esophageal Achalasia/physiopathology ; Esophageal Achalasia/therapy* ; Esophagoscopy/instrumentation ; Esophagoscopy/methods* ; Esophagus/diagnostic imaging* ; Esophagus/physiopathology ; Female ; Gastrointestinal Motility* ; Humans ; Male ; Middle Aged ; Patient Selection ; Predictive Value of Tests ; Radiography ; Radionuclide Imaging ; Remission Induction ; Republic of Korea ; Retrospective Studies ; Time Factors ; Treatment Outcome
Keywords
Achalasia ; Prognosis ; Pneumatic dilatation ; Esophagography ; Esophageal transit scintigraphy
Abstract
BACKGROUND:
Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia.
METHODS:
Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30) and the post-PD rate of reduction of R 30 ((Pre R 30 - Post R 30)/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed.
RESULTS:
Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4-8). R 30 and T 1/2 were, respectively, 61.8 % and 38.5 min before EPD and 20 % and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 %) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 %, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD.
CONCLUSION:
Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient's short-term response to EPD.
Full Text
http://link.springer.com/article/10.1007%2Fs10620-013-2906-4
DOI
10.1007/s10620-013-2906-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Rhee, Kwang Won(이광원)
Jeon, Han Ho(전한호)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98532
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