Table 5.
Summary of the Evidence Supporting Pneumatic Balloon Dilatation in Patients with Achalasia
| Study | Country | Study design | Participants | Intervention | Comparator | Follow-up duration | Outcome |
|---|---|---|---|---|---|---|---|
| 2016, Tan et al64 | China | Retrospective cohort study | Treatment-naïve patients with achalasia | PBD, n = 9 | POEM, n = 12 | POEM group; 26.0 mo | Treatment success (Eckardt score ≤ 3) rate |
| Treatment success rate at 24 mo and 36 mo | |||||||
| PBD group; 70.7 mo | POEM vs PBD: 100.0% vs 44.4%, 100.0% vs 33.3%, P < 0.05 | ||||||
| 2013, Chan et al65 | Hong Kong | Retrospective cohort study | Patients with achalasia without prior treatment | PBD, n = 50 | LHM, n = 18 | LHM group; 34.0 mo | Recurrent dysphagia: PBD vs LHM, 55.1% vs 26.7%, P = 0.235 |
| PBD group; 64.0 mo | Reintervention rate was needed: PBD vs LHM, 42.1% vs 9.1%, P = 0.045 | ||||||
| 2008, Emami et al66 | Iran | Retrospective cohort study | Treatment-naïve patients with achalasia | PBD, n = 45 | Myotomy, n = 20 | Myotomy group; 34.9 mo | Patient satisfaction scores of the myotomy vs PBD groups: 8.05 ± 2.37 and 7.67 ± 2.49, respectively (P = NS) |
| PBD group; 25.3 mo | |||||||
| 2014, Jung et al67 | Korea | Retrospective cohort study | Patients with achalasia without prior treatment | PBD, n = 12 | Botox (n = 25) | Median 61.0 mo | The symptom-free period was significantly longer in the PBD group (P = 0.036) than the Botox group. |
| 2007, Kostic et al68 | Sweden | RCT | Treatment-naïve patients with achalasia | PBD, n = 26 | LHM, n = 25 | 1 yr | Pneumatic dilatation was associated with significantly more treatment failures (P = 0.04). |
| 2016, Saleh et al69 | Netherlands | Retrospective analysis of prospective database. | Recurrent or persistent symptoms of achalasia after Heller myotomy | PBD, n = 24 | None | 6.5 yr | Success rate of 57.0% using 30-mm and 35-mm balloons. |
| 2010, Tanaka et al70 | Japan | Prospective study | Treatment-naïve patients with achalasia | PBD, n = 55 | None | 28.0 mo | Successful in 41 of 55 cases (74.5%) |
| 2001, Allescher et al71 | Germany | RCT | Patients with achalasia with/ without prior treatment | PBD, n = 14 | Botox, n = 23 | Botox group; 1375 day | Overall response rate: Botox vs PBD, 82.6% vs 92.9% |
| Symptom remission rate at 2 yr for Botox = 30.0%. | |||||||
| PBD group; 1477 day | After 24 mo, a single balloon dilation was superior to a single botulinum toxin injection. | ||||||
| 2009, Zhu et al59 | China | RCT | Treatment-naïve patients with achalasia | PBD, n = 28 | Botox, n = 29 | 2 yr | Symptom remission rate: Botox vs PBD vs PBD + Botox, 14.0% vs 36.0% vs 57.0% |
| PBD + Botox,n = 30 | |||||||
| 2011, Boeckxstaens et al72 | EU | RCT | Treatment-naïve patients with achalasia | PBD, n = 95 | LHM, n = 106 | 43 mo | Rate of the therapeutic success: PBD vs LHM, 90.0% vs 93.0% (at the 1-yr follow-up) and 86.0% vs 90.0% (at the 2-yr follow-up) (P = 0.46) |
PBD, pneumatic balloon dilatation; POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; NS, not significant; RCT, randomized controlled trial.