For patients with primary achalasia the clinical success of pneumatic balloon dilatation can be predicted from the residual fraction of radionuclide during esophageal transit scintigraphy

Han Ho Jeon, Young Hoon Youn, Kwangwon Rhee, Jie-Hyun Kim, HyoJin Park, Jeffrey L. Conklin

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5 Citations (Scopus)

Abstract

Background: Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia. Methods: Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30 ) and the post-PD rate of reduction of R 30 ((Pre R 30 - Post R 30 )/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed. Results: Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4-8). R 30 and T 1/2 were, respectively, 61.8 % and 38.5 min before EPD and 20 % and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 %) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 %, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD. Conclusion: Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient's short-term response to EPD.

Original languageEnglish
Pages (from-to)375-382
Number of pages8
JournalDigestive Diseases and Sciences
Volume59
Issue number2
DOIs
Publication statusPublished - 2014 Feb 1

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Esophageal Achalasia
Radioisotopes
Radionuclide Imaging
Dilatation
Esophagus

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

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title = "For patients with primary achalasia the clinical success of pneumatic balloon dilatation can be predicted from the residual fraction of radionuclide during esophageal transit scintigraphy",
abstract = "Background: Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia. Methods: Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30 ) and the post-PD rate of reduction of R 30 ((Pre R 30 - Post R 30 )/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed. Results: Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4-8). R 30 and T 1/2 were, respectively, 61.8 {\%} and 38.5 min before EPD and 20 {\%} and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 {\%}) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 {\%}, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD. Conclusion: Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient's short-term response to EPD.",
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For patients with primary achalasia the clinical success of pneumatic balloon dilatation can be predicted from the residual fraction of radionuclide during esophageal transit scintigraphy. / Jeon, Han Ho; Youn, Young Hoon; Rhee, Kwangwon; Kim, Jie-Hyun; Park, HyoJin; Conklin, Jeffrey L.

In: Digestive Diseases and Sciences, Vol. 59, No. 2, 01.02.2014, p. 375-382.

Research output: Contribution to journalArticle

TY - JOUR

T1 - For patients with primary achalasia the clinical success of pneumatic balloon dilatation can be predicted from the residual fraction of radionuclide during esophageal transit scintigraphy

AU - Jeon, Han Ho

AU - Youn, Young Hoon

AU - Rhee, Kwangwon

AU - Kim, Jie-Hyun

AU - Park, HyoJin

AU - Conklin, Jeffrey L.

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Background: Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia. Methods: Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30 ) and the post-PD rate of reduction of R 30 ((Pre R 30 - Post R 30 )/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed. Results: Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4-8). R 30 and T 1/2 were, respectively, 61.8 % and 38.5 min before EPD and 20 % and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 %) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 %, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD. Conclusion: Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient's short-term response to EPD.

AB - Background: Esophageal transit scintigraphy (ETS) and esophagography have long been used to evaluate patients with achalasia. The objectives of our study were to evaluate the efficacy of endoscopic pneumatic dilatation (EPD) as treatment for Koreans with achalasia and to determine which findings from ETS and esophagography predict successful treatment of achalasia. Methods: Patients with achalasia who were treated by EPD between April 2002 and January 2012 were recruited. We defined the success of EPD as 6 months or more of clinical remission without symptoms or a decrease in the Eckardt scores by at least two points and a total Eckardt score not exceeding 3. We reviewed the percentage of maximum scintigraphic activity retained in the esophagus at 30 s (R 30 ) and the post-PD rate of reduction of R 30 ((Pre R 30 - Post R 30 )/Pre R 30 × 100) by ETS. Possible predictive factors determined by ETS and esophagography were analyzed. Results: Our study included 53 eligible patients. The median symptom score (Eckardt score) was 5 (4-8). R 30 and T 1/2 were, respectively, 61.8 % and 38.5 min before EPD and 20 % and 4.19 min after EPD. Successful EPD was achieved for 40 of 53 (75.47 %) patients. Age (≥40, p = 0.027) and post-PD rate of reduction of R 30 (>20 %, p = 0.003) were best prognostic indicators of clinical success. There were no perforations related to EPD. Conclusion: Older age and a post-PD rate of reduction of R 30 were strongly associated with better outcomes. Examination with ETS before and after EPD can be used to objectively assess a patient's short-term response to EPD.

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