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Pneumatic dilation for the treatment of persistent post-laparoscopic fundoplication dysphagia: long-term efficacy and safety

par Gkolfakis, Paraskevas;Lorenzo, Diane;Blero, Daniel ;Louis, Hubert ;Lemmers, Arnaud ;Arvanitakis, Marianna ;Eisendrath, Pierre ;Devière, Jacques
Référence Expert Review of Gastroenterology and Hepatology, 16, 3, page (289-296)
Publication Publié, 2022-06-01

Article révisé par les pairs

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Résumé :

Background: Post-laparoscopic fundoplication (LF) dysphagia occurs in 5%–17% of patients and optimal management remains a topic of expert discussion. We assessed the efficacy and safety of pneumatic dilation (PD) in patients with persistent post-lLF dysphagia. Methods: Medical files of patients treated with PD for persistent post-fundoplication-associated dysphagia were reviewed. The primary outcome was long-term clinical success. Secondary endpoints were initial clinical success, dysphagia recurrence rate, and PD-related complication incidence. Results: Overall, 46 patients (74% women, 57.9±11.9 years) underwent 74 PD (mean: 1.6±0.8). A 30 mm, 35 mm, and 40 mm balloon was used in 45.9%, 43.2%, and 10.8%, respectively, of dilations. Among 45 patients with available follow-up, the overall long-term success rate of PD was 31/45 (68.9% [55.4–82.4]). Initial clinical success was 36/45 (80% [68.3–91.7]). Dysphagia recurred in 9 patients (25%; 95%CI 10.9–39.1) and 4 of these were effectively treated with a new dilation. Among 14 non-responders to PD, 11 underwent surgery. Four complications (2 perforations, 1 muscularis dilaceration, and 1 peri-procedural bleeding) occurred in 4 patients (incidence: 5.4% [95%CI; 0.3–10.6]) and were treated with partially covered self-expandable esophageal stents andhemostatic clips. Conclusions: Pneumatic balloon dilation for post-fundoplication-associated symptoms is associated with a satisfactory long-term success rate and acceptable safety profile.