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

ABSTRACT

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.

KEYWORDS:

• Laparoscopic fundoplication
• dysphagia
• pneumatic dilation
• endoscopy
• nissen

Acknowledgments

The authors would like to acknowledge the contribution of a medical writer, Sandy Field, PhD, for English language editing and formatting of this manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.

Notes on contributors

Paraskevas Gkolfakis

P Gkolfakis and D Lorenzo acquired the data, performed the analysis, drafted the manuscript, and approved the final manuscript; D Blero, H Louis, P Eisendrath, and A Lemmers revised the draft critically for important intellectual content and approved the final manuscript; J Devière conceived the idea, revised the draft critically for important intellectual content, and approved the final manuscript. All authors agreed to be accountable for all aspects of the work.