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More Procedures after Pneumatic Dilatation for Achalasia

Much higher incidence of secondary procedures after primary pneumatic dilatation compared to myotomy

TUESDAY, Nov. 7 (HealthDay News) -- Patients with achalasia treated initially with pneumatic dilatation have a greater risk for a subsequent intervention at one, five and 10 years compared to those who had primary surgical myotomy, according to a report in the Nov. 8 issue of the Journal of the American Medical Association.

Steven R. Lopushinsky, M.D., of the University of Toronto in Ontario, Canada, and a colleague conducted a retrospective comparative outcomes study of 1,461 adults with achalasia, 1,181 of whom had pneumatic dilatation (80.8 percent) and 280 of whom had surgical myotomy (19.2 percent).

The risk for any secondary intervention for primary pneumatic dilatation was 36.8 percent at one year, 56.2 percent at five years and 63.5 percent at 10 years. The risk for intervention after primary surgical myotomy was 16.4 percent at one year, 30.3 percent at five years and 37.5 percent at 10 years.

"Subsequent intervention after the initial treatment of achalasia is common. Although the risk of subsequent interventions among persons treated with surgical myotomy in typical practice settings is higher than previously thought, the risk of subsequent intervention is greater among persons treated with pneumatic dilatation than with surgical myotomy. This difference is attributable to the use of subsequent pneumatic dilatation rather than surgical procedures," the authors conclude.

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