Background: The use of pneumatic dilation (PD) is well established in adults with achalasia; however, it is less commonly used in children. Objective: To evaluate the efficacy of PD in pediatric achalasia and to define predictive factors for its treatment failure. Design: Single-center, prospective cohort study. Setting: Academic tertiary referral center. Patients: Twenty-four patients with achalasia were enrolled from January 2004 to November 2009 and were followed for a median of 6 years. Intervention: PD was performed with the patients under general anesthesia. Main Outcome Measurements: Efficacy and safety of PD. Follow-up was performed by using the Eckardt score, barium swallow contrast studies, and esophageal manometry at baseline; 1, 3, and 6 months after dilation; and every year thereafter. A Cox regression model was used to identify independent predictors of failure after the first PD. Results: The PD success rate was 67%. In 8 patients, the first PD failed, but the parents of one patient refused a second PD and requested surgery. Of the 7 patients who underwent repeated treatment, the second PD failed in 3 (43%). Overall, only 3 of the 24 patients underwent surgery (overall success rate after a maximum of 3 PDs was 87%). Multivariate analysis showed that only older age was independently associated with a higher probability of the procedure success (hazard ratio [HR] 0.66; 95% CI, 0.45-0.97). Limitations: Small sample size, single-center study. Conclusions: PD is a safe and effective technique in the management of pediatric achalasia. Young age is an independent negative predictive factor for successful clinical outcome. Copyright © 2012 by the American Society for Gastrointestinal Endoscopy.

Pneumatic Balloon Dilation in Pediatric Achalasia: Efficacy and Factors Predicting Outcome At a Single Tertiary Pediatric Gastroenterology Center / DI NARDO, Giovanni; Rossi, Paolo; Oliva, Salvatore; Aloi, Marina; Cozzi, Denis; Frediani, Simone; Redler, Adriano; Mallardo, Saverio; Ferrari, Federica; Cucchiara, Salvatore. - In: GASTROINTESTINAL ENDOSCOPY. - ISSN 0016-5107. - STAMPA. - 75:S(2012), pp. 166-166. (Intervento presentato al convegno Digestive Disease Week (DDW) tenutosi a San Diego, CA nel MAY 19-22, 2012) [10.1016/j.gie.2012.06.035].

Pneumatic Balloon Dilation in Pediatric Achalasia: Efficacy and Factors Predicting Outcome At a Single Tertiary Pediatric Gastroenterology Center

DI NARDO, Giovanni;ROSSI, PAOLO;OLIVA, SALVATORE;ALOI, MARINA;COZZI, Denis;FREDIANI, SIMONE;REDLER, Adriano;MALLARDO, SAVERIO;FERRARI, Federica;CUCCHIARA, Salvatore
2012

Abstract

Background: The use of pneumatic dilation (PD) is well established in adults with achalasia; however, it is less commonly used in children. Objective: To evaluate the efficacy of PD in pediatric achalasia and to define predictive factors for its treatment failure. Design: Single-center, prospective cohort study. Setting: Academic tertiary referral center. Patients: Twenty-four patients with achalasia were enrolled from January 2004 to November 2009 and were followed for a median of 6 years. Intervention: PD was performed with the patients under general anesthesia. Main Outcome Measurements: Efficacy and safety of PD. Follow-up was performed by using the Eckardt score, barium swallow contrast studies, and esophageal manometry at baseline; 1, 3, and 6 months after dilation; and every year thereafter. A Cox regression model was used to identify independent predictors of failure after the first PD. Results: The PD success rate was 67%. In 8 patients, the first PD failed, but the parents of one patient refused a second PD and requested surgery. Of the 7 patients who underwent repeated treatment, the second PD failed in 3 (43%). Overall, only 3 of the 24 patients underwent surgery (overall success rate after a maximum of 3 PDs was 87%). Multivariate analysis showed that only older age was independently associated with a higher probability of the procedure success (hazard ratio [HR] 0.66; 95% CI, 0.45-0.97). Limitations: Small sample size, single-center study. Conclusions: PD is a safe and effective technique in the management of pediatric achalasia. Young age is an independent negative predictive factor for successful clinical outcome. Copyright © 2012 by the American Society for Gastrointestinal Endoscopy.
2012
01 Pubblicazione su rivista::01a Articolo in rivista
Pneumatic Balloon Dilation in Pediatric Achalasia: Efficacy and Factors Predicting Outcome At a Single Tertiary Pediatric Gastroenterology Center / DI NARDO, Giovanni; Rossi, Paolo; Oliva, Salvatore; Aloi, Marina; Cozzi, Denis; Frediani, Simone; Redler, Adriano; Mallardo, Saverio; Ferrari, Federica; Cucchiara, Salvatore. - In: GASTROINTESTINAL ENDOSCOPY. - ISSN 0016-5107. - STAMPA. - 75:S(2012), pp. 166-166. (Intervento presentato al convegno Digestive Disease Week (DDW) tenutosi a San Diego, CA nel MAY 19-22, 2012) [10.1016/j.gie.2012.06.035].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/459115
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