Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Dont know about actual figures but they told me the same thing here in England and its a bit of an unknown as they dont know how strong your e is and its the skill of the surgeon. andy England On 22 March 2010 13:30, davster13 <davster13@...> wrote: > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > Apparently if it tears they have to do an open surgery to repair it and > there is a 2 week stay in the hospital to recover. Has anyone else been > told this? > Has anyone suffered a tear duraing a dialtion? I am scheduled for my 3rd > (I think) dialation on Friday at UC San Fran by a former college of Dr > Patti. In fact Dr Patti referred me to Dr Ostroff. > > Thanks > > Dave > Cow County Calif > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 On 3/22/2010 6:30 AM, davster13 wrote: > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > 1 in 5, or 20%, seems high unless this is your personal risk and not a general risk. Are you talking about dilatation after myotomy? See: Management of esophageal perforation after pneumatic dilation for achalasia http://www.ncbi.nlm.nih.gov/pubmed/11058860 " Over a 20-year period, 445 dilations for achalasia were performed in 371 patients. There were 10 esophageal perforations. Nine patients were referred for surgery and were successfully managed with a transabdominal repair. " Incidence, clinical management and outcomes of esophageal perforations after endoscopic dilatation. http://www.ncbi.nlm.nih.gov/pubmed/18027320 " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon dilatations for achalasia, 79 balloon dilatations for other reasons such as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 dilatations with Savary bougies. The overall incidence of perforation based on the number of procedures was 2.2% (8 perforations/365 procedures) and 3.2% (8/248 patients) based on the number of patients. The perforation rate was 1.9% for bougie dilatation, 0% for balloon dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five patients were treated surgically and 3 patients were managed conservatively. The mean hospital stay was 14 days (7-33 days). One patient in whom the perforation was recognized 16 days after the dilatation died. " They say the risk goes up after previous treatments, dilatation or myotomy, so your risk is probably higher than those studies imply. Maybe I can find something about that kind of risk later. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Thanks for the info! Yes, it is a dilatation after myotomy. I had my myotomy with dor fundo almost 5 years ago > > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > > > > 1 in 5, or 20%, seems high unless this is your personal risk and not a > general risk. Are you talking about dilatation after myotomy? > > See: > Management of esophageal perforation after pneumatic dilation for achalasia > http://www.ncbi.nlm.nih.gov/pubmed/11058860 > " Over a 20-year period, 445 dilations for achalasia were performed in > 371 patients. There were 10 esophageal perforations. Nine patients were > referred for surgery and were successfully managed with a transabdominal > repair. " > > Incidence, clinical management and outcomes of esophageal perforations > after endoscopic dilatation. > http://www.ncbi.nlm.nih.gov/pubmed/18027320 > " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range > 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon > dilatations for achalasia, 79 balloon dilatations for other reasons such > as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 > dilatations with Savary bougies. The overall incidence of perforation > based on the number of procedures was 2.2% (8 perforations/365 > procedures) and 3.2% (8/248 patients) based on the number of patients. > The perforation rate was 1.9% for bougie dilatation, 0% for balloon > dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five > patients were treated surgically and 3 patients were managed > conservatively. The mean hospital stay was 14 days (7-33 days). One > patient in whom the perforation was recognized 16 days after the > dilatation died. " > > They say the risk goes up after previous treatments, dilatation or > myotomy, so your risk is probably higher than those studies imply. Maybe > I can find something about that kind of risk later. > > notan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 I don't understand why there is a need to get dilation after having had the surgery. I thought surgery was supposed to be the " permanent " fix. If the muscle is cut during the surgery how does it end up getting tight again? > > > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > > > > > > > 1 in 5, or 20%, seems high unless this is your personal risk and not a > > general risk. Are you talking about dilatation after myotomy? > > > > See: > > Management of esophageal perforation after pneumatic dilation for achalasia > > http://www.ncbi.nlm.nih.gov/pubmed/11058860 > > " Over a 20-year period, 445 dilations for achalasia were performed in > > 371 patients. There were 10 esophageal perforations. Nine patients were > > referred for surgery and were successfully managed with a transabdominal > > repair. " > > > > Incidence, clinical management and outcomes of esophageal perforations > > after endoscopic dilatation. > > http://www.ncbi.nlm.nih.gov/pubmed/18027320 > > " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range > > 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon > > dilatations for achalasia, 79 balloon dilatations for other reasons such > > as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 > > dilatations with Savary bougies. The overall incidence of perforation > > based on the number of procedures was 2.2% (8 perforations/365 > > procedures) and 3.2% (8/248 patients) based on the number of patients. > > The perforation rate was 1.9% for bougie dilatation, 0% for balloon > > dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five > > patients were treated surgically and 3 patients were managed > > conservatively. The mean hospital stay was 14 days (7-33 days). One > > patient in whom the perforation was recognized 16 days after the > > dilatation died. " > > > > They say the risk goes up after previous treatments, dilatation or > > myotomy, so your risk is probably higher than those studies imply. Maybe > > I can find something about that kind of risk later. > > > > notan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 davster13 wrote: > Yes, it is a dilatation after myotomy. > I am not having much luck finding the risk of perforation due to dilatation after a myotomy. I have found some about repeated dilatations. There are some studies that say that most perforation happen on the first dilatation. Kind of counter intuitive. Here are two studies that make that statement and there are others: Risk factors for immediate complications after progressive pneumatic dilation for achalasia. http://www.ncbi.nlm.nih.gov/pubmed/10235189 " Five hundred four dilations were performed in 237 consecutive achalasic patients... Perforations occurred in 6 of 7 patients during the first dilation. " Risk factors of oesophageal perforation during pneumatic dilatation for achalasia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383221/ " ... 270 pneumatic dilatations were performed in 218 patients. ... Eight oesophageal perforations occurred (3%). ... All perforations occurred during the first dilatation. " In the first study over half of the dilatation were on patients that had already had a dilatation before. In the second study only a fifth of the dilatation are repeat. If the risk was much higher for repeat dilatation those results would be hard to get by chance. Even if the risk stays the same it would be a bit of odd luck to get those results. This does seem to imply that the risk actually goes down for repeat dilatations. Which is even more amazing when you consider that often a larger dilator is used on the second dilatation. Perhaps it is the same after myotomy. If so, and I do say if, then the first one is your riskiest. I am sure we have heard from a number of members to this group that have expressed their doctors concerns for doing dilatations after myotomy, but perhaps those doctors are just giving the intuitive belief when the studies are actually counter intuitive. I did find a small study that found repeat dilatation to be more risky but it was a very small study and much more likely to be chance. There may be other contrary studies but these two seem to be what are cited by others. Here is one study that addresses the dilatation after myotomy. Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. http://www.ncbi.nlm.nih.gov/pubmed/15492600 " A total of 139 PDs performed (117 untreated cases, 22 failed HM): 2 perforations in untreated cases and none in failed HM group... CONCLUSIONS: PD perforation risk is not higher after HM. " Again, that is a small study as far as the HM (Heller Myotomy) patients go and the HM patients only had one dilatation after the myotomy. It may not mean much, but it too gets cited. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Jan wrote: > Also, scar tissue can build up from the first Myotomy. > Scar tissue can also result from acid reflux. Scar tissue tends to shrink and be stiff which can make places that are harder for food to pass by. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Only the LES " valve " gets cut Dave > > > > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > > > > > > > > > > 1 in 5, or 20%, seems high unless this is your personal risk and not a > > > general risk. Are you talking about dilatation after myotomy? > > > > > > See: > > > Management of esophageal perforation after pneumatic dilation for achalasia > > > http://www.ncbi.nlm.nih.gov/pubmed/11058860 > > > " Over a 20-year period, 445 dilations for achalasia were performed in > > > 371 patients. There were 10 esophageal perforations. Nine patients were > > > referred for surgery and were successfully managed with a transabdominal > > > repair. " > > > > > > Incidence, clinical management and outcomes of esophageal perforations > > > after endoscopic dilatation. > > > http://www.ncbi.nlm.nih.gov/pubmed/18027320 > > > " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range > > > 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon > > > dilatations for achalasia, 79 balloon dilatations for other reasons such > > > as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 > > > dilatations with Savary bougies. The overall incidence of perforation > > > based on the number of procedures was 2.2% (8 perforations/365 > > > procedures) and 3.2% (8/248 patients) based on the number of patients. > > > The perforation rate was 1.9% for bougie dilatation, 0% for balloon > > > dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five > > > patients were treated surgically and 3 patients were managed > > > conservatively. The mean hospital stay was 14 days (7-33 days). One > > > patient in whom the perforation was recognized 16 days after the > > > dilatation died. " > > > > > > They say the risk goes up after previous treatments, dilatation or > > > myotomy, so your risk is probably higher than those studies imply. Maybe > > > I can find something about that kind of risk later. > > > > > > notan > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2010 Report Share Posted March 23, 2010  Some of us have learned the hard way that there is no " permanent fix " because there is nothing permanent about our bodies. Believe me, back in 1991 I thought I had the " permanent fix " also. I'm sure Notan can handle the technical aspect of your question as to how it the LES ends up getting tight again. But, being less knowledgeable, I can suggest a couple of reasons. The muscle can heal and get tight again. Perhaps not enough muscle was cut. Perhaps the wrap was made too tight. Perhaps the esophagus has gotten either, twisted, tortured, grossly dialated or has sagged below the level of the stomach. All of these things alone or in combination can lead to the symptom of the muscle feeling too tight again. After we have the surgery and have experienced the initial euphoria of being able to eat relatively normally again, we must be mindful that we now have a useless " pipe " connecting our the back of our throat to the entrance to our stomach which must be treated with " respect. "  While some of the degeneration is beyond our control, nevertheless there is much we can do to improve our chances that this " pipe " won't need replacement in the future. ________________________________ From: blicky77 <blicky77@...> achalasia Sent: Mon, March 22, 2010 2:58:27 PM Subject: Re: Risks of Dialation  I don't understand why there is a need to get dilation after having had the surgery. I thought surgery was supposed to be the " permanent " fix. If the muscle is cut during the surgery how does it end up getting tight again? > > > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > > > > > > > 1 in 5, or 20%, seems high unless this is your personal risk and not a > > general risk. Are you talking about dilatation after myotomy? > > > > See: > > Management of esophageal perforation after pneumatic dilation for achalasia > > http://www.ncbi. nlm.nih.gov/ pubmed/11058860 > > " Over a 20-year period, 445 dilations for achalasia were performed in > > 371 patients. There were 10 esophageal perforations. Nine patients were > > referred for surgery and were successfully managed with a transabdominal > > repair. " > > > > Incidence, clinical management and outcomes of esophageal perforations > > after endoscopic dilatation. > > http://www.ncbi. nlm.nih.gov/ pubmed/18027320 > > " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range > > 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon > > dilatations for achalasia, 79 balloon dilatations for other reasons such > > as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 > > dilatations with Savary bougies. The overall incidence of perforation > > based on the number of procedures was 2.2% (8 perforations/ 365 > > procedures) and 3.2% (8/248 patients) based on the number of patients. > > The perforation rate was 1.9% for bougie dilatation, 0% for balloon > > dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five > > patients were treated surgically and 3 patients were managed > > conservatively. The mean hospital stay was 14 days (7-33 days). One > > patient in whom the perforation was recognized 16 days after the > > dilatation died. " > > > > They say the risk goes up after previous treatments, dilatation or > > myotomy, so your risk is probably higher than those studies imply. Maybe > > I can find something about that kind of risk later. > > > > notan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2010 Report Share Posted March 23, 2010 Also, scar tissue can build up from the first Myotomy. I had the first surgery in 1974 and numerous dilations until my second Myotomy in 2008. By 2008, the scar tissue had built up & my esophagus was an “L†shape (maybe what you have described as “sagged below the stomachâ€). Jan From: achalasia [mailto:achalasia ] On Behalf Of RICHARD FRIEDMAN Sent: Monday, March 22, 2010 9:39 PM achalasia Subject: Re: Re: Risks of Dialation Some of us have learned the hard way that there is no " permanent fix " because there is nothing permanent about our bodies. Believe me, back in 1991 I thought I had the " permanent fix " also. I'm sure Notan can handle the technical aspect of your question as to how it the LES ends up getting tight again. But, being less knowledgeable, I can suggest a couple of reasons. The muscle can heal and get tight again. Perhaps not enough muscle was cut. Perhaps the wrap was made too tight. Perhaps the esophagus has gotten either, twisted, tortured, grossly dialated or has sagged below the level of the stomach. All of these things alone or in combination can lead to the symptom of the muscle feeling too tight again. After we have the surgery and have experienced the initial euphoria of being able to eat relatively normally again, we must be mindful that we now have a useless " pipe " connecting our the back of our throat to the entrance to our stomach which must be treated with " respect. " While some of the degeneration is beyond our control, nevertheless there is much we can do to improve our chances that this " pipe " won't need replacement in the future. ________________________________ From: blicky77 <blicky77@... <mailto:blicky77%40> > achalasia <mailto:achalasia%40> Sent: Mon, March 22, 2010 2:58:27 PM Subject: Re: Risks of Dialation I don't understand why there is a need to get dilation after having had the surgery. I thought surgery was supposed to be the " permanent " fix. If the muscle is cut during the surgery how does it end up getting tight again? > > > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > > > > > > > 1 in 5, or 20%, seems high unless this is your personal risk and not a > > general risk. Are you talking about dilatation after myotomy? > > > > See: > > Management of esophageal perforation after pneumatic dilation for achalasia > > http://www.ncbi. nlm.nih.gov/ pubmed/11058860 > > " Over a 20-year period, 445 dilations for achalasia were performed in > > 371 patients. There were 10 esophageal perforations. Nine patients were > > referred for surgery and were successfully managed with a transabdominal > > repair. " > > > > Incidence, clinical management and outcomes of esophageal perforations > > after endoscopic dilatation. > > http://www.ncbi. nlm.nih.gov/ pubmed/18027320 > > " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range > > 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon > > dilatations for achalasia, 79 balloon dilatations for other reasons such > > as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 > > dilatations with Savary bougies. The overall incidence of perforation > > based on the number of procedures was 2.2% (8 perforations/ 365 > > procedures) and 3.2% (8/248 patients) based on the number of patients. > > The perforation rate was 1.9% for bougie dilatation, 0% for balloon > > dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five > > patients were treated surgically and 3 patients were managed > > conservatively. The mean hospital stay was 14 days (7-33 days). One > > patient in whom the perforation was recognized 16 days after the > > dilatation died. " > > > > They say the risk goes up after previous treatments, dilatation or > > myotomy, so your risk is probably higher than those studies imply. Maybe > > I can find something about that kind of risk later. > > > > notan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2010 Report Share Posted March 23, 2010 Thanks Jan, The build up from scar tissue is a good point. There are many factors contributing to the myotomy being less than a " permanent fix " and its very important that patients having this surgery realize that going in. Clearly, 18 years ago I did not. While it maybe the best " solution " we have now, over time the " fix " can get " broken " through nobody's fault. We should all have a " game plan " for after the surgery, such as living a life style which gives us the maximum amount of " mileage " out of our non-functioning esophagus, plus checkups at resonable intervals to make sure that nothing is slowly happening that will someday require another myotomy or esophagectomy. ________________________________ From: jan dolph <jan.dolph@...> achalasia Sent: Tue, March 23, 2010 12:45:27 AM Subject: RE: Re: Risks of Dialation  Also, scar tissue can build up from the first Myotomy. I had the first surgery in 1974 and numerous dilations until my second Myotomy in 2008. By 2008, the scar tissue had built up & my esophagus was an “L†shape (maybe what you have described as “sagged below the stomachâ€). Jan From: achalasia@grou ps.com [mailto:achalasia@grou ps.com] On Behalf Of RICHARD FRIEDMAN Sent: Monday, March 22, 2010 9:39 PM achalasia@grou ps.com Subject: Re: Re: Risks of Dialation Some of us have learned the hard way that there is no " permanent fix " because there is nothing permanent about our bodies. Believe me, back in 1991 I thought I had the " permanent fix " also. I'm sure Notan can handle the technical aspect of your question as to how it the LES ends up getting tight again. But, being less knowledgeable, I can suggest a couple of reasons. The muscle can heal and get tight again. Perhaps not enough muscle was cut. Perhaps the wrap was made too tight. Perhaps the esophagus has gotten either, twisted, tortured, grossly dialated or has sagged below the level of the stomach. All of these things alone or in combination can lead to the symptom of the muscle feeling too tight again. After we have the surgery and have experienced the initial euphoria of being able to eat relatively normally again, we must be mindful that we now have a useless " pipe " connecting our the back of our throat to the entrance to our stomach which must be treated with " respect. " While some of the degeneration is beyond our control, nevertheless there is much we can do to improve our chances that this " pipe " won't need replacement in the future. ____________ _________ _________ __ From: blicky77 <blicky77 (DOT) com <mailto:blicky77% 40> > achalasia@grou ps.com <mailto:achalasia% 40groups. com> Sent: Mon, March 22, 2010 2:58:27 PM Subject: Re: Risks of Dialation I don't understand why there is a need to get dilation after having had the surgery. I thought surgery was supposed to be the " permanent " fix. If the muscle is cut during the surgery how does it end up getting tight again? > > > My doctor says there is a 1 in 5 chance of tearing the E during dialation. > > > > > > > 1 in 5, or 20%, seems high unless this is your personal risk and not a > > general risk. Are you talking about dilatation after myotomy? > > > > See: > > Management of esophageal perforation after pneumatic dilation for achalasia > > http://www.ncbi. nlm.nih.gov/ pubmed/11058860 > > " Over a 20-year period, 445 dilations for achalasia were performed in > > 371 patients. There were 10 esophageal perforations. Nine patients were > > referred for surgery and were successfully managed with a transabdominal > > repair. " > > > > Incidence, clinical management and outcomes of esophageal perforations > > after endoscopic dilatation. > > http://www.ncbi. nlm.nih.gov/ pubmed/18027320 > > " RESULTS: 248 patients (148 male, 100 female, mean age 58 years, range > > 14-87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon > > dilatations for achalasia, 79 balloon dilatations for other reasons such > > as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 > > dilatations with Savary bougies. The overall incidence of perforation > > based on the number of procedures was 2.2% (8 perforations/ 365 > > procedures) and 3.2% (8/248 patients) based on the number of patients. > > The perforation rate was 1.9% for bougie dilatation, 0% for balloon > > dilatation and 5-4% for pneumatic balloon dilatation for achalasia. Five > > patients were treated surgically and 3 patients were managed > > conservatively. The mean hospital stay was 14 days (7-33 days). One > > patient in whom the perforation was recognized 16 days after the > > dilatation died. " > > > > They say the risk goes up after previous treatments, dilatation or > > myotomy, so your risk is probably higher than those studies imply. Maybe > > I can find something about that kind of risk later. > > > > notan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2010 Report Share Posted March 23, 2010 If your physician says he personally has a 20% perforation rate, I would RUN AWAY as fast as possible. I wouldn't let anyone touch me if they had a perf rate over 4%, and most experienced specialists should be even lower than that, IMO. Debbi in Michigan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2010 Report Share Posted March 23, 2010 It wasn't the perferator, I mean the dialator that said that. I have to go to UCSF 5 hours aways for these so when I changed medical practices I checked with their E expert to see if he could do this locally and he gave me that number. I forgot what the actual doc said, maybe I'll call and ask. The new doc thinks my wrap is too tight and thinks I should go back and get another myotompty but open this time. He is agasint lap myotomys, thinks it too dark and tight in there to do a good job without laying you open. Luckily, he doesn't do these he refers them all to UCSF Thanks > > If your physician says he personally has a 20% perforation rate, I would RUN AWAY as fast as possible. > > I wouldn't let anyone touch me if they had a perf rate over 4%, and most experienced specialists should be even lower than that, IMO. > > Debbi in Michigan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 24, 2010 Report Share Posted March 24, 2010 what is the best way to take care of and get the most milage out of our non-functioning E's? I want to try and take care as much as as possible to avoid letting it get stretched out requiring a need for removal of it later on. I'm 32 and (hopefully) have many years ahead of me. I've been presenting with symptoms for 8 months now and am at the point now where i need to decide if I should get a dilation or myotomy. What other things can I do to take care of me E? Not try and push it too hard? Sometimes it hurts down by the LES when I'm having a eating bad day. Good days are when I can feel food going to my stomach (albeit still very slowly). I try not to rush eating. I've always been a slow eating but now I'm SUPER slow. I tend to avoid going out to eat or if I do, I'll only get something very small cause it will take me that long to eat as it does someone else an entire meal. > > Yes, it is a dilatation after myotomy. > > > > I am not having much luck finding the risk of perforation due to > dilatation after a myotomy. I have found some about repeated > dilatations. There are some studies that say that most perforation > happen on the first dilatation. Kind of counter intuitive. Here are two > studies that make that statement and there are others: > > Risk factors for immediate complications after progressive pneumatic > dilation for achalasia. > http://www.ncbi.nlm.nih.gov/pubmed/10235189 > " Five hundred four dilations were performed in 237 consecutive > achalasic patients... Perforations occurred in 6 of 7 patients during > the first dilation. " > > Risk factors of oesophageal perforation during pneumatic dilatation for > achalasia. > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383221/ > " ... 270 pneumatic dilatations were performed in 218 patients. ... Eight > oesophageal perforations occurred (3%). ... All perforations occurred > during the first dilatation. " > > In the first study over half of the dilatation were on patients that had > already had a dilatation before. In the second study only a fifth of the > dilatation are repeat. If the risk was much higher for repeat dilatation > those results would be hard to get by chance. Even if the risk stays the > same it would be a bit of odd luck to get those results. This does seem > to imply that the risk actually goes down for repeat dilatations. Which > is even more amazing when you consider that often a larger dilator is > used on the second dilatation. > > Perhaps it is the same after myotomy. If so, and I do say if, then the > first one is your riskiest. I am sure we have heard from a number of > members to this group that have expressed their doctors concerns for > doing dilatations after myotomy, but perhaps those doctors are just > giving the intuitive belief when the studies are actually counter > intuitive. I did find a small study that found repeat dilatation to be > more risky but it was a very small study and much more likely to be > chance. There may be other contrary studies but these two seem to be > what are cited by others. > > Here is one study that addresses the dilatation after myotomy. > > Pneumatic dilation for the treatment of achalasia in untreated patients > and patients with failed Heller myotomy. > http://www.ncbi.nlm.nih.gov/pubmed/15492600 > " A total of 139 PDs performed (117 untreated cases, 22 failed HM): 2 > perforations in untreated cases and none in failed HM group... > CONCLUSIONS: PD perforation risk is not higher after HM. " > > Again, that is a small study as far as the HM (Heller Myotomy) patients > go and the HM patients only had one dilatation after the myotomy. It may > not mean much, but it too gets cited. > > notan > Quote Link to comment Share on other sites More sharing options...
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