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Comparison between botulinum injection and removable covered self-expanding metal stents for the treatment of achalasia.

Abstract：

BACKGROUND:Intrasphincteric injection of botulinum toxin (BTX) and removable self-expanding metal stents (SEMS) have both been used for the treatment of achalasia. AIM:To compare the effectiveness and long-term outcome of SEMS placement and BTX injection in patients with achalasia. METHODS:A total of 110 patients with newly diagnosed achalasia were enrolled in the study between July 2003 and December 2009. The patients received either BTX injection (n = 51) or SEMS placement (n = 59). Clinical symptoms, objective parameters, and long-term clinical outcomes were evaluated after 7 and 30 days and then every 6 months until withdrawal from the study. The mean duration of follow-up was 28 months (range 10-36 months). RESULTS:Improvements in global symptom and dysphagia scores and in basal lower esophageal sphincter pressure were significantly more marked in the SEMS group than in the BTX group (all P < 0.05). After 12 months, the remission rate in the SEMS group (81.28 %) was statistically significantly higher than that in the BTX group (64.58; P < 0.05). At 36 months, the remission rates in the two groups were 49.1 and. 4.2 %, respectively (P < 0.01). The symptom-free interval was 831 ± 46 days in the SEMS group and 522 ± 42 days in the BTX group (P < 0.01). No side effects were reported with BTX treatment. In the SEMS group there were 13 episodes of chest pain, nine cases of regurgitation, and four stent migrations. No serious complications occurred. CONCLUSION:Removable SEMS was associated with better long-term outcomes than BTX injection in patients with achalasia.

journal_name

Dig Dis Sci

journal_title

Digestive diseases and sciences

authors

Cai XB,Dai YM,Wan XJ,Zeng Y,Liu F,Wang D,Zhou H

doi

10.1007/s10620-013-2564-6

subject

Has Abstract

pub_date

2013-07-01 00:00:00

pages

1960-6

issue

7

eissn

0163-2116

issn

1573-2568

journal_volume

58

pub_type

临床试验,杂志文章

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