Faculty Collaboration Database

The treatment of achalasia patients with esophageal varices: an international study. United European Gastroenterol J 2019 May;7(4):565-572

Date

05/09/2019

Pubmed ID

31065374

Pubmed Central ID

PMC6488800

DOI

10.1177/2050640619838114

Scopus ID

2-s2.0-85065094860 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk.

METHODS: Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group.

RESULTS: Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 ± 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller's myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1; p < 0.0001) at 6 months follow-up, with treatment outcomes resembling those of 20 non-cirrhotic achalasia patients who underwent similar therapy. No patients had recorded complications of bleeding or perforation.

CONCLUSION: This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices.

Author List

Pesce M, Magee C, Holloway RH, Gyawali CP, Roman S, Pioche M, Savarino E, Quader F, Sarnelli G, Sanagapalli S, Bredenoord AJ, Sweis R

MESH terms used to index this publication - Major topics in bold

Aged
Botulinum Toxins
Dilatation
Esophageal Achalasia
Esophageal Sphincter, Lower
Esophageal and Gastric Varices
Esophagoscopy
Female
Follow-Up Studies
Heller Myotomy
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome