Outcomes of pneumatic dilatation and Heller's myotomy for achalasia in England between 2005 and 2016

Research output: Contribution to journalArticlepeer-review

Authors

  • Philip R Harvey
  • Ben Coupland
  • Jemma Mytton
  • Felicity Evison
  • Prashant Patel
  • And 1 others
  • Nigel J Trudgill

Colleges, School and Institutes

External organisations

  • Department of Gastroenterology, Sandwell and West Birmingham Hospitals, West Bromwich, UK.
  • Cancer Bioinfomatics Group, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
  • Department of Health Informatics; Queen Elizabeth Hospital; Edgbaston Birmingham United Kingdom

Abstract

INTRODUCTION: Achalasia is a disorder characterised by failed relaxation of the lower oesophageal sphincter. The aim of this study was to examine, at a national level, the long-term outcomes of achalasia therapies.

METHODS: Hospital Episode Statistics include diagnostic and procedural data for all English National Health Service-funded hospital admissions. Subjects with a code for achalasia who had their initial treatment between January 2006 and December 2015 were grouped by treatment; pneumatic dilatation (PD) or surgical Heller's myotomy (HM). Procedural failure was defined as time to a further episode of the same therapy or a change to a different therapy. Up to three PDs were permitted without being considered a therapy failure.

RESULTS: 6938 subjects were included; 3619 (52.2%) were men and median age at diagnosis was 59 (IQR 43-75) years. 4748 (68.4%) initially received PD and 2190 (31.6%) HM. The perforation rate following PD was 1.6%. Mortality at 30 days was 0.0% for HM and 1.9% for PD, and <8% after perforation following PD. Factors associated with increased mortality after PD included age quintile 66-77 (OR 4.55 (95% CI 2.00 to 10.38), p<0.001), >77 (9.78 (4.33 to 22.06), p<0.001); Charlson comorbidity score >4 (2.87 (2.08 to 3.95), p<0.001); previous HM (2.47 (1.33 to 4.62), p<0.001); and repeat PD 1-3 (1.58 (1.15 to 2.16), p=0.005), >3 (1.97 (1.21 to 3.19), p=0.006). Durability of up to 3 PD and HM over 10 years of follow-up was 86.2% and 81.9%, respectively (p<0.001).

DISCUSSION: The efficacy of PD for achalasia appears to be greater than HM over 10 years. There was no mortality associated with HM, but 1.9% of subjects died within 30 days of PD. Mortality was associated with increasing age, comorbidity, previous HM and repeat PD.

Bibliographic note

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Details

Original languageEnglish
Pages (from-to)1146-1151
Number of pages6
JournalGut
Volume68
Issue number7
Early online date3 Jan 2019
Publication statusPublished - Jul 2019

Keywords

  • Adult, Aged, Dilatation/adverse effects, England/epidemiology, Esophageal Achalasia/etiology, Esophageal Sphincter, Lower, Female, Heller Myotomy/adverse effects, Humans, Male, Middle Aged, Postoperative Complications/epidemiology, Retrospective Studies, Treatment Outcome