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Expanding the Role of Pneumatic Dilation for Non-Achalasia Patients – A Comparative Study

Published:October 10, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.032
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      Background and Aims

      Treatment options for non-achalasia obstructive disorders of esophagogastric junction (EGJ) are limited. The aim of this study was to assess the treatment efficacy of pneumatic dilation (PD) for the disorders of the esophagogastric junction outflow obstruction (EGJOO) and post fundoplication esophagogastric junction obstruction (PF-EGJO) and to assess attitudes regarding training in PD.

      Methods

      This was a two-part study. The main study was a prospective single-center study comparing treatment outcome after PD in patients with EGJOO and PF-EGJO, defined using manometry criteria, vs achalasia. Treatment success was defined as a post-PD Eckardt score (ES) of ≤ 2 at the longest duration of follow-up available. In a survey sub-study, a 2-question survey was sent to advanced endoscopy fellowship sites in the US (n=78) regarding training in PD.

      Results

      Of the 58% of respondents to the advanced endoscopy program director survey, 2/3 reported no training in PD at their program. The primary rationale cited was lack of a clinical need for PD. Sixty-one patients (15 Achalasia, 32 EGJOO, and 14 PF-EGJO) were included in the main study with outcomes available at a mean follow-up of 8.8 months. Overall, mean ES decreased from 6.30 to 2.89 (p < 0.0001); and mean % improvement in symptoms reported by patients was 55.3%. ES of ≤ 2 was achieved by 33/61 patients (54.1%).

      Conclusions

      PD is an effective treatment for the non-achalasia obstructive disorders of the EGJ. There may be a current gap in training and technical expertise in PD.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      EGJ (Esophagogastric junction), PD (Pneumatic Dilation), EGJOO (Esophagogastric Junction Outflow Obstruction), PF-EGJO (Post-Fundoplication Esophagogastric Junction Obstruction), ES (Eckardt Score), LES (Lower esophageal sphincter), HRM (High-resolution manometry), GERD (Gastroesophageal Reflux Disease), ASGE (American Society of Gastrointestinal Endoscopy), FLIP (Functional lumen imaging probe), BEDQ (Brief Esophageal Dysphagia Questionnaire), PSI (Pounds-per-square-inch), BLESP (Basal lower esophageal sphincter pressure), IRP (Integrated relaxation pressure), DI (Distensibility index), BMI (Body mass index), EoE (Eosinophilic esophagitis)
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