Ten-Year Outcome of Surgical Myotomy and Pneumatic Dilatation in Achalasia, Single Institute Experience in Thailand

Introduction : Less was known regarding the effectiveness of treatment in achalasia. This study aimed to compare outcome of surgical myotomy and pneumatic dilatation. Methods : Medical records of patients diagnosed as achalasia (2002-2013) were reviewed. Only patients underwent surgical myotomy or pneumatic dilatation were included. Standardized questionnaire of symptoms were collected before and after treatment and in December 2013. Each symptom score ranged from 0-3 depending on symptom severity. Patients who had total symptom score more than 2 or underwent second intervention were considered as unfavorable outcome. Results : There were 23 patients underwent pneumatic dilatation and 23 patients underwent surgical myotomy with no treatment mortality. Ten-year favorable outcome was 80% for surgical myotomy and 43.5% for single pneumatic dilatation (p<0.01). If repeated pneumatic dilatations were not considered as unfavorable outcome in pneumatic dilatation, ten-year favorable outcome was comparable to that of surgical myotomy (78.7% vs 80%). Conclusion : Surgical myotomy is more effective than single pneumatic dilatation in term of ten-year outcome for treatment of achalasia. However, if repeated pneumatic dilatation are included, ten-year outcome is comparable to that of surgical myotomy.