Long-term outcomes of pneumatic balloon dilation versus peroral endoscopic myotomy in type I and II achalasia patients: a propensity score–matched analysis
Issued Date
2024-01-01
Resource Type
ISSN
00165107
eISSN
10976779
Scopus ID
2-s2.0-85212185270
Pubmed ID
39477022
Journal Title
Gastrointestinal Endoscopy
Rights Holder(s)
SCOPUS
Bibliographic Citation
Gastrointestinal Endoscopy (2024)
Suggested Citation
Geeratragool T., Boonumnuay P., Maneerattanaporn M., Sunsaneevithayakul S., Jaruchaiyong A., Penrasamee N., Laothanasin P., Chuenprapai P., Phalanusitthepha C., Leelakusolvong S. Long-term outcomes of pneumatic balloon dilation versus peroral endoscopic myotomy in type I and II achalasia patients: a propensity score–matched analysis. Gastrointestinal Endoscopy (2024). doi:10.1016/j.gie.2024.10.046 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102472
Title
Long-term outcomes of pneumatic balloon dilation versus peroral endoscopic myotomy in type I and II achalasia patients: a propensity score–matched analysis
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Abstract
Background and Aims: Peroral endoscopic myotomy (POEM) shows higher efficacy than pneumatic balloon dilation (PBD) for type I and II achalasia over 2 years. However, long-term durability beyond 5 years remains under-investigated. This study assessed the long-term efficacy of PBD versus POEM. Methods: This retrospective comparative study examined treatment-naive achalasia patients who underwent either PBD or POEM. Cohort balance was achieved through propensity score (PS) matching based on age, sex, Eckardt score, and Charlson Comorbidity Index. The primary outcome was the time to a second intervention. Secondary outcomes were treatment failure, Eckardt score, number of intervention sessions, weight gain, and adverse events. Results: Of the 127 patients, 67 underwent PBD and 60 underwent POEM, with an average follow-up of 7 years (interquartile range, 5-10). After PS matching, 100 patients with 1:1 matching were included in the analysis. Baseline characteristics, including clinical, endoscopic, and manometric attributes, were comparable between groups. The POEM group had a significantly longer time to a second intervention than the PBD group (hazard ratio,.139; 95% confidence interval,.048-.405) and underwent less endoscopic sessions (P <.001 by linear marginal model analysis) within the first 2 years. Beyond 2 years, subsequent interventions were comparable between groups. There were no differences in the Eckardt score or weight gain. Hospital stays were shorter in the PBD group (2 vs 4 days, P <.001). POEM patients had more adverse events, including perforation. Conclusions: POEM demonstrated greater long-term durability than PBD, but PBD was associated with shorter hospital stays and fewer adverse events.