Post written by Nikita Desai, MD, from the Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
The focus of our study was to evaluate the treatment efficacy of pneumatic dilation (PD) for the disorders of esophagogastric junction outflow obstruction (EGJOO) and postfundoplication esophagogastric junction obstruction (PF-EGJO) and to assess attitudes about training in PD.
A growing number of patients are being diagnosed with nonachalasia disorders, including EGJOO and PF-EGJO. These patients have a significant impairment in their quality of life with limited therapeutic options. We felt PD may be a safe and efficacious therapeutic intervention, but data about its use in this population are limited. We also wanted to review current training perceptions and frequency of PD at advanced endoscopy programs.
We used a 2-part study with the first part a prospective, single-center study comparing treatment outcomes after PD and the second part a 2-question survey addressing training in PD that was sent to advanced endoscopy sites in the United States.
Treatment success was a post-PD Eckardt score (ES) of ≤2, which was achieved in 33 of 61 patients (54.1%) who were diagnosed by manometry as having EGJOO, PF-EGJO, or achalasia.
Across all 3 groups, mean ES decreased from 6.30 to 2.89 (P < .0001). These findings suggest PD is a safe and effective therapy for obstructive disorders of the esophagogastric junction (EGJ).
However, we found 67% of American Society for Gastrointestinal Endoscopy—supported advanced endoscopy programs do not train in PD, with 57% of those citing low clinical utility of PD as the rationale.
In the future, it will be necessary to perform clinical trials to explore the use of PD for nonachalasia indications. As the body of literature grows, our hope is the clinical utility of PD in EGJ disorders will become clear, leading to increased training of this technique at advanced endoscopy sites.
Outcomes of the pneumatic dilation protocol are shown for each esophageal diagnosis. A, Magnitude of improvement in the Eckardt score. B, Patient-reported percentage of symptom improvement. Values are mean ± standard error of the mean. EGJOO, Esophagogastric junction outflow obstruction; PF-EGJO, postfundoplication esophagogastric junction obstruction.
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