Method selection and evaluation of midtrimester and long-term therapeutic efficiency of achalasia with three methods of interventional procedure

Objective: To study method selection and evaluation of midtrimester and long-term therapeutic efficiency of achalasia with three methods of interventional procedure. Method: 50 cases achalasia with 30 cases performing with balloon dilation (group A) and 5 cases with permanent metallic internal stent dilation (group B) and 15 cases with temporary metallic internal stent dilation (group C) under fluoroscopy. Results: 30 cases of group A had 56 times of dilations (mean 1.9 times). The mean diameter of cardia was (2.4 +- 1.2) mm before dilation and (9.7 +- 3.0) mm after dilation. The mean dysphagia scores were 2.4 +- 1.2 grades before dilation and 1.0 +- 0.3 grades after dilation. Complications in 30 cases included chest pain (n = 9), reflux (n = 8) and bleeding (n = 3). 18(60%) of 30 cases showed dysphagia relapse during follow-up over 6 months, 18(90%) of 20 cases showed dysphagia relapse during follow-up over 12 months. 5 uncovered expandable metal stents were permanently placed in 5 cases of group B. The mean diameter of cardia was (3.2 +- 2.0) mm before dilation and (18.4 +- 1.7) mm after dilation. The mean dysphagia scores were (2.4 +- 1.1) grade before dilation and (0.4 +- 0.2) grade after dilation. Complications in 5 cases included chest pain (n = 3), reflux (n = 4), bleeding (n = 1) and hyperplasia of granulation tissue (n 2). 3(60%) in 5 cases showed dysphagia relapse during follow-up over 6 months, 1(50%) in 2 cases were dysphagia relapse during follow-up over 12 months. 15 covered expandable metal stents were temporarily placed in 15 cases of group C and drawn out at the 3-7 days via gastroscopy. The mean diameter of cardia was (3.4 +- 2.9) mm before dilation and (14.7 +- 2.9) mm after dilation. The mean dysphagia scores were (2.5 +- 1.1) grades before dilation and (0.6 +- 0.3) grades after dilation. Complications in 15 cases included chest pain (n = 3), reflux (n = 3) and bleeding (n = 2). 3(20%) in 15 cases showed dysphagia relapse during follow-up over 6 months, 2 (20%) in 10 cases had dysphagia relapse during follow-up over 12 months. All stents insertion and drawing were technically successful. Follow-up time of group A, B and C were from 6 months to 33 months. Conclusions: The effective method for curing achalasia with interventional procedure were graded balloon dilation and temporary metal internal stent dilation. Temporary metal internal stent dilation was first method of choice for achalasia with interventional procedure in midtrimester and long-term therapeutic efficiency