Endoscopic pneumatic dilation<i>versus</i> endoscopic stent placement in treatment of achalasia: a meta-analysis _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Longlong ¹ ,  LI Feng ¹ , WANG Genwang ¹ , QIAN Binbin ^1,2 , FAN Qiang ^1,2 , GU Yuelei ¹ ,  YANG Sunhu ¹

1. Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, P.R.China;
2. Bengbu Medical College, Bengbu, Anhui 233003, P.R.China;

Corresponding author：

YANG Sunhu, Email: yangsh06@126.com

Keywords：

achalasia; pneumatic dilation; stent placement; meta-analysis

DOI：

10.7507/1007-9424.201607029

Video：

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Objective To systematically evaluate efficacy and safety of endoscopic pneumatic dilation and endoscopic stent placement in treatment of achalasia. Methods Eligible studies comparing the pneumatic dilation and the stent placement in treatment of achalasia were identified by an electronic search of MedLine, Embase, ISI Web of Science, the Cochrane Database, China Biology Medicine and Wanfang databases from inception to December 2015. Two reviewers independently screened the literatures, extracted data, and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 4 randomized controlled trials including 343 patients with achalasia (176 cases in the pneumatic dilation group, 167 cases in the stent placement group) were subjected to the final analysis. The results of meta-analysis showed that the postoperative short term symptom relief rate had no significant difference between the pneumatic dilation group and the stent placement group 〔RR=1.03, 95%CI (0.95, 1.12),P=0.53〕, the postoperative 2-year symptom relief rate of the stent placement group was significantly higher than that of the pneumatic dilation group 〔RR=0.77, 95%CI (0.64, 0.92),P=0.005〕, but the complications rate of the stent placement group was significantly higher as compared with the pneumatic dilation group 〔RR=0.52, 95%CI (0.40, 0.69),P<0.000 01〕 too. Conclusions Although this meta-analysis has some shortcomings, preliminary results show that short term effects of pneumatic dilation and stent placement in treatment of achalasia are effective, long term effect of stent placement in treatment of achalasia is better as compared with pneumatic dilation, but it’s complications rate is higher. So in clinical diagnosis and treatment, effect, risk, patient’s physical condition, and demand should be considered together; during treatment, we should pay attention to adverse reactions and prepare adequately in order to reducing complications. When complications occur, we should take timely symptomatic treatment.

Citation： ZHANG Longlong, LI Feng, WANG Genwang, QIAN Binbin, FAN Qiang, GU Yuelei, YANG Sunhu. Endoscopic pneumatic dilationversus endoscopic stent placement in treatment of achalasia: a meta-analysis . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 482-488. doi: 10.7507/1007-9424.201607029 Copy

1.	Gockel I, Müller M, Schumacher J. Achalasia–a disease of unknown cause that is often diagnosed too late. Dtsch Arztebl Int, 2012, 109(12): 209-214.
2.	Wei M, Yang T, Yang X,et al. Peroral esophageal myotomyversus laparoscopic Heller’s myotomy for achalasia: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2015, 25(2): 123-129.
3.	张龙龙, 王根旺, 钱彬彬, 等. 贲门失弛缓症动物模型制备的研究进展. 中国普外基础与临床杂志, 2016, 23(5): 638-640. F3.
4.	白俊清, 高占峰. 贲门失弛缓症的治疗进展及疗效分析. 临床和实验医学杂志, 2015, 14(7): 608-609.
5.	Luján-Sanchis M, Suárez-Callol P, Monzó-Gallego A,et al. Management of primary achalasia: The role of endoscopy. World J Gastrointest Endosc, 2015, 7(6): 593-605.
6.	Familiari P, Greco S, Volkanovska A,et al. Achalasia: current treatment options. Expert Rev Gastroenterol Hepatol, 2015, 9(8): 1101-1114.
7.	Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol, 2016, 9: 71-82.
8.	包文晗, 段丽萍. 贲门失弛缓症的治疗进展. 中国微创外科杂志, 2016, 16(3): 281-285.
9.	臧凤莉, 白宁, 王宝菊, 等. 贲门失弛缓症治疗的现状和进展. 现代生物医学进展, 2015, 15(6): 1160-1164.
10.	农长深, 林瑶光. 内镜下治疗贲门失弛缓症的研究进展. 内科, 2012, 7(2): 177-179.
11.	Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilationversus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev, 2014, (12): CD005046.
12.	Esposito D, Maione F, D’Alessandro A,et al. Endoscopic treatment of esophageal achalasia. World J Gastrointest Endosc, 2016, 8(2): 30-39.
13.	Di Nardo G, Rossi P, Oliva S,et al. Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center. Gastrointest Endosc, 2012, 76(5): 927-932.
14.	Coppola F, Gaia S, Rolle E,et al. Temporary endoscopic metallic stent for idiopathic esophageal achalasia. Surg Innov, 2014, 21(1): 11-14.
15.	Zhao H, Wan XJ, Yang CQ. Comparison of endoscopic balloon dilation with metal stent placement in the treatment of achalasia. J Digest Dis, 2015, 16(6): 311-318.
16.	朱悦琦, 程英升, 李明华, 等. 暂时性贲门支架置入与球囊扩张治疗贲门失弛缓症患者的比较研究. 介入放射学杂志, 2011, 20(9): 700-705.
17.	Zhu YQ, Cui WG, Cheng YS,et al. Evaluation of biodegradable paclitaxel-eluting nanofibre-covered metal stents for the treatment of benign cardia stricture in an experimental model. Br J Surg, 2013, 100(6): 784-793.
18.	Wang L, Zhu YQ, Cheng YS,et al. Temporary placement of a paclitaxel or rapamycin-eluting stent is effective to reduce stenting induced inflammatory reaction and scaring in benign cardia stricture models. Turk J Gastroenterol, 2014, 25 Suppl 1: 69-74.
19.	尼维, 程英升, 陈维雄, 等. 暂时性金属内支架治疗贲门失弛缓症对食管动力的影响. 介入放射学杂志, 2003, 12(2): 124-125.
20.	DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
21.	Higgins JP, Thompson SG, Deeks JJ,et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
22.	Li YD, Cheng YS, Li MH,et al. Temporary self-expanding metallic stents and pneumatic dilation for the treatment of achalasia: a prospective study with a long-term follow-up. Dis Esophagus, 2010, 23(5): 361-367.
23.	唐红娟, 刘玉伶, 王冰, 等. 球囊扩张和金属支架置入治疗贲门失弛缓症的疗效比较. 中国医师进修杂志, 2010, 33(28): 66-67.
24.	秦咏梅, 张彩风, 刘竹娥, 等. 内镜下支架置入治疗贲门失迟缓症27例. 世界华人消化杂志, 2010, 18(19): 2043-2046.
25.	卢嘉茵, 邱小蕾. 三级球囊扩张与植入覆膜可回收支架治疗贲门失弛缓症的对比观察. 现代消化及介入诊疗, 2015, 20(3): 259-261.
26.	Qian L, Wang B, Li K,et al. Long-term efficacy of pneumatic dilation and esophageal stenting for the treatment of achalasia. Digestion, 2013, 88(4): 209-216.
27.	Zhu YQ, Cheng YS, Tang GY,et al. Comparison of temporary stent insertion with pneumatic dilation of the same diameter in the treatment of achalasia patients: a retrospective study. J Gastroenterol Hepatol, 2010, 25(3): 499-505.
28.	Schoppmeyer K, Golsong J, Schiefke I,et al. Antireflux stents for palliation of malignant esophagocardial stenosis. Dis Esophagus, 2007, 20(2): 89-93.
29.	De Palma GD, Lovino P, Masone S,et al. Self-expanding metal stents for endoscopic treatment of esophageal achalasia unresponsive to conventional treatments. Long-term results in eight patients. Endoscopy, 2001, 33(12): 1027-1030.
30.	Ruiz Cuesta P, Hervás Molina AJ, Jurado García J,et al. Pneumatic dilation in the treatment of achalasia. Gastroenterol Hepatol, 2013, 36(8): 508-512.
31.	Honein K, Slim R, Yaghi C,et al. Pneumatic dilatation of achalasia: local experience in treating 41 patients. J Med Liban, 2006, 55(1): 15-18.
32.	Dobrucali A, Erzin Y, Tuncer M,et al. Long-term results of graded pneumatic dilatation under endoscopic guidance in patients with primary esophageal achalasia. World J Gastroenterol, 2004, 10(22): 3322-3327.
33.	Pasricha PJ, Ravich WJ, Hendrix TR,et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 332(12): 774-778.
34.	Aljebreen AM, Samarkandi S, Al-Harbi T,et al. Efficacy of pneumatic dilatation in Saudi achalasia patients. Saudi J Gastroenterol, 2014, 20(1): 43-47.

1. Gockel I, Müller M, Schumacher J. Achalasia–a disease of unknown cause that is often diagnosed too late. Dtsch Arztebl Int, 2012, 109(12): 209-214.
2. Wei M, Yang T, Yang X,et al. Peroral esophageal myotomyversus laparoscopic Heller’s myotomy for achalasia: a meta-analysis. J Laparoendosc Adv Surg Tech A, 2015, 25(2): 123-129.
3. 张龙龙, 王根旺, 钱彬彬, 等. 贲门失弛缓症动物模型制备的研究进展. 中国普外基础与临床杂志, 2016, 23(5): 638-640. F3.
4. 白俊清, 高占峰. 贲门失弛缓症的治疗进展及疗效分析. 临床和实验医学杂志, 2015, 14(7): 608-609.
5. Luján-Sanchis M, Suárez-Callol P, Monzó-Gallego A,et al. Management of primary achalasia: The role of endoscopy. World J Gastrointest Endosc, 2015, 7(6): 593-605.
6. Familiari P, Greco S, Volkanovska A,et al. Achalasia: current treatment options. Expert Rev Gastroenterol Hepatol, 2015, 9(8): 1101-1114.
7. Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state of the art. Clin Exp Gastroenterol, 2016, 9: 71-82.
8. 包文晗, 段丽萍. 贲门失弛缓症的治疗进展. 中国微创外科杂志, 2016, 16(3): 281-285.
9. 臧凤莉, 白宁, 王宝菊, 等. 贲门失弛缓症治疗的现状和进展. 现代生物医学进展, 2015, 15(6): 1160-1164.
10. 农长深, 林瑶光. 内镜下治疗贲门失弛缓症的研究进展. 内科, 2012, 7(2): 177-179.
11. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilationversus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev, 2014, (12): CD005046.
12. Esposito D, Maione F, D’Alessandro A,et al. Endoscopic treatment of esophageal achalasia. World J Gastrointest Endosc, 2016, 8(2): 30-39.
13. Di Nardo G, Rossi P, Oliva S,et al. Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center. Gastrointest Endosc, 2012, 76(5): 927-932.
14. Coppola F, Gaia S, Rolle E,et al. Temporary endoscopic metallic stent for idiopathic esophageal achalasia. Surg Innov, 2014, 21(1): 11-14.
15. Zhao H, Wan XJ, Yang CQ. Comparison of endoscopic balloon dilation with metal stent placement in the treatment of achalasia. J Digest Dis, 2015, 16(6): 311-318.
16. 朱悦琦, 程英升, 李明华, 等. 暂时性贲门支架置入与球囊扩张治疗贲门失弛缓症患者的比较研究. 介入放射学杂志, 2011, 20(9): 700-705.
17. Zhu YQ, Cui WG, Cheng YS,et al. Evaluation of biodegradable paclitaxel-eluting nanofibre-covered metal stents for the treatment of benign cardia stricture in an experimental model. Br J Surg, 2013, 100(6): 784-793.
18. Wang L, Zhu YQ, Cheng YS,et al. Temporary placement of a paclitaxel or rapamycin-eluting stent is effective to reduce stenting induced inflammatory reaction and scaring in benign cardia stricture models. Turk J Gastroenterol, 2014, 25 Suppl 1: 69-74.
19. 尼维, 程英升, 陈维雄, 等. 暂时性金属内支架治疗贲门失弛缓症对食管动力的影响. 介入放射学杂志, 2003, 12(2): 124-125.
20. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
21. Higgins JP, Thompson SG, Deeks JJ,et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
22. Li YD, Cheng YS, Li MH,et al. Temporary self-expanding metallic stents and pneumatic dilation for the treatment of achalasia: a prospective study with a long-term follow-up. Dis Esophagus, 2010, 23(5): 361-367.
23. 唐红娟, 刘玉伶, 王冰, 等. 球囊扩张和金属支架置入治疗贲门失弛缓症的疗效比较. 中国医师进修杂志, 2010, 33(28): 66-67.
24. 秦咏梅, 张彩风, 刘竹娥, 等. 内镜下支架置入治疗贲门失迟缓症27例. 世界华人消化杂志, 2010, 18(19): 2043-2046.
25. 卢嘉茵, 邱小蕾. 三级球囊扩张与植入覆膜可回收支架治疗贲门失弛缓症的对比观察. 现代消化及介入诊疗, 2015, 20(3): 259-261.
26. Qian L, Wang B, Li K,et al. Long-term efficacy of pneumatic dilation and esophageal stenting for the treatment of achalasia. Digestion, 2013, 88(4): 209-216.
27. Zhu YQ, Cheng YS, Tang GY,et al. Comparison of temporary stent insertion with pneumatic dilation of the same diameter in the treatment of achalasia patients: a retrospective study. J Gastroenterol Hepatol, 2010, 25(3): 499-505.
28. Schoppmeyer K, Golsong J, Schiefke I,et al. Antireflux stents for palliation of malignant esophagocardial stenosis. Dis Esophagus, 2007, 20(2): 89-93.
29. De Palma GD, Lovino P, Masone S,et al. Self-expanding metal stents for endoscopic treatment of esophageal achalasia unresponsive to conventional treatments. Long-term results in eight patients. Endoscopy, 2001, 33(12): 1027-1030.
30. Ruiz Cuesta P, Hervás Molina AJ, Jurado García J,et al. Pneumatic dilation in the treatment of achalasia. Gastroenterol Hepatol, 2013, 36(8): 508-512.
31. Honein K, Slim R, Yaghi C,et al. Pneumatic dilatation of achalasia: local experience in treating 41 patients. J Med Liban, 2006, 55(1): 15-18.
32. Dobrucali A, Erzin Y, Tuncer M,et al. Long-term results of graded pneumatic dilatation under endoscopic guidance in patients with primary esophageal achalasia. World J Gastroenterol, 2004, 10(22): 3322-3327.
33. Pasricha PJ, Ravich WJ, Hendrix TR,et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med, 1995, 332(12): 774-778.
34. Aljebreen AM, Samarkandi S, Al-Harbi T,et al. Efficacy of pneumatic dilatation in Saudi achalasia patients. Saudi J Gastroenterol, 2014, 20(1): 43-47.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Endoscopic pneumatic dilationversus endoscopic stent placement in treatment of achalasia: a meta-analysis

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