This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Achalasia: management, outcome and surveillance in a specialist unit. BJS 2000; 87: 364-365.
Published: 6th December 2002
Authors: A. M. Harris, S. M. Dresner, S. M. Griffin
Method
A prospective cohort of 40 patients with a radiological and manometric diagnosis of achalasia who presented to this unit between 1991 and 1998 were studied; the male: female ratio was 1: 1 and the median age 38 (range 15–84) years. Twenty‐one patients presented de novo, seven had previously undergone cardiomyotomy and 12 were referred following unsuccessful dilatation.
Results
Some 36 patients were treated with balloon dilatation (Microvasive achalasia balloon, 35/40 mm). Results were graded 1–4 (1, asymptomatic; 2, symptomatic but significantly improved; 3, symptomatic with no change; and 4, symptomatic but worse); 29 of 36 patients were grade 1 at subsequent follow‐up and the remaining seven were grade 2 (median follow‐up 17 (range 5–96) months). There was a single complication of oesophageal perforation which was treated conservatively with full recovery. Following intervention, patients were enrolled in a prospective surveillance programme of chromoendoscopy at 2‐year intervals; in a total of 74 patient‐years' follow‐up, two superficial squamous cell carcinomas (SCCs) and one adenocarcinoma (following cardiomyotomy) were detected, giving a relative risk of one cancer in 25 patient‐years.