Long-term outcomes of Heller's myotomy and balloon dilatation in childhood achalasia

被引:21
作者
Saliakellis, Efstratios [1 ]
Thapar, Nikhil [1 ,2 ]
Roebuck, Derek [3 ]
Cristofori, Fernanda [1 ]
Cross, Kate [4 ]
Kiely, Edward [4 ]
Curry, Joseph [4 ]
Lindley, Keith [1 ]
Borrelli, Osvaldo [1 ]
机构
[1] Great Ormond St Hosp NHS Fdn Trust, Dept Gastroenterol, Neurogastroenterol & Motil Unit, London, England
[2] UCL Great Ormond St Inst Child Hlth, Stem Cells & Regenerat Med, London, England
[3] Great Ormond St Hosp Children NHS Fdn Trust, Intervent Radiol Div, Dept Radiol, London, England
[4] Great Ormond St Hosp NHS Fdn Trust, SNAPS Dept, London, England
关键词
Esophageal achalasia; Dysphagia; Children; Heller's myotomy; Balloon dilatation; ESOPHAGEAL ACHALASIA; PNEUMATIC DILATION; IDIOPATHIC ACHALASIA; PEDIATRIC ACHALASIA; MOTILITY DISORDERS; SURGICAL-TREATMENT; BOTULINUM TOXIN; CHILDREN; ESOPHAGOMYOTOMY; MANAGEMENT;
D O I
10.1007/s00431-017-2924-x
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Achalasia is a rare esophageal motility disorder: its optimal treatment in children is still a matter of debate. Records of children treated for achalasia, over an 18-year period, were reviewed. Forty-eight children (median age at diagnosis 10 years; range 3-17 years) were identified. Twenty-eight patients were initially treated with Heller's myotomy (HM) and 20 with balloon dilatation (BD). At last follow-up (median 3 years; range 1-5.5 years), 43.8% (21/48) of children were symptom free. The number of asymptomatic children was significantly higher among those treated initially with HM compared to BD (HM 15/28, 53.6% BD 6/20, 30%, p < 0.05). All children who underwent BD required HM due to symptom recurrence. The median (range) total number of procedures was significantly higher in the BD group (BD 3 (1-7); HM 1 (1-5); p < 0.05) with a shorter time to the second intervention (BD 14 months, 95%CI 4-24; HM 58 months, 95%CI 38-79; p < 0.05). Of 108 procedures, esophageal perforation occurred in two children after HM (two out of 48 HM procedures in total, 4%) and one child after BD (1/60, 1.7%). Conclusion: Less than half of children with achalasia are symptom free after initial treatment with either BD or HM. HM, however, when performed as first procedure, provided longer symptom-free period and reduced need for subsequent intervention.
引用
收藏
页码:899 / 907
页数:9
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