The achalasia is a rare primary esophageal motor disorder characterized by\nrelaxation disorders of the lower esophageal sphincter and absence of the\nesophageal body peristalsis. Several studies suggest that the response to the\nendoscopic treatment depends on several predictors. The aim of our study\nwas to evaluate the endoscopic treatment of esophageal achalasia and identify\nthe predictive factors of endoscopic treatment response. Patients and Methods:\nThis is a retrospective analytical study of 78 patients with achalasia,\nmanaged in the gastroenterology department of the university medical center\nHassan II-Fez, during a period of 5 years (January 2009 to December 2014).\nThe diagnosis of achalasia was retained on a set of clinical, endoscopic, manometric\nand radiological arguments. A graded dilation protocol starting\nwith a 35 mm balloon three times for 30 seconds in progressive pressure between\n5 and 8 psi was performed. We used the Eckardt score to evaluate the\nclinical remission. Results: During the study period, 78 patients were included.\nThe average age of our patients was 47 years old [18 - 81] with a\nsex-ratio M/F of 1.05. The average of Eckardt score before dilation was 5.9 [3\n- 9]. An average of 1.41 dilation sessions was performed per patient with\n85.9% of the initial success rate (n = 67). Initial success without further dilation\nsessions was achieved in 55.1% of our patients (n = 43). A clinical recurrence\nrequiring further dilation sessions was observed in 30.8% of the cases (n\n= 24). The average relapse time after first dilation success was 2.7 years, 75%\noccurs within the first year. Dilation failure was retained in 14 patients\n(17.9%) requiring surgery. Only one post-dilation perforation was noted. In\nmultivariate analysis, only odynophagia and the number of dilatation sessions\nwere factors of failure of the endoscopic dilation. Conclusion: Pneumatic dilation\nis a minimally morbid and effective procedure. Our work showed that odynophagia, and the number of dilation sessions, are two predictive factors\nof endoscopic treatment failure.
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