Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study
Background: Pneumatic dilation (PD) is an effective first line treatment option for many patients with achalasia. PD use may be limited in adults with achalasia who are older than 65 because of concern for adverse events (AE), and less efficacious therapies are often utilized. We explored the peripr...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6682 |
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| author | Nir Bar Christopher Vélez Trisha S. Pasricha Tamar Thurm Dana Ben-Ami Shor Roy Dekel Yishai Ron Kyle Staller Braden Kuo |
| author_facet | Nir Bar Christopher Vélez Trisha S. Pasricha Tamar Thurm Dana Ben-Ami Shor Roy Dekel Yishai Ron Kyle Staller Braden Kuo |
| author_sort | Nir Bar |
| collection | DOAJ |
| description | Background: Pneumatic dilation (PD) is an effective first line treatment option for many patients with achalasia. PD use may be limited in adults with achalasia who are older than 65 because of concern for adverse events (AE), and less efficacious therapies are often utilized. We explored the periprocedural safety profile of PD in older adults. Methods: An international real world cross-sectional study of patients undergoing PD between 2006–2020 in two tertiary centers. Thirty-day AEs were compared between older adults (65 and older) with achalasia and younger patients. Results: A total of 252 patients underwent 319 PDs. In 319 PDs, 18 (5.7%) complications occurred: 6 (1.9%) perforations and 12 (3.8%) emergency department referrals with benign (non-perforation) chest pain, of which 9 (2.8%) were hospitalized. No bleeding or death occurred within 30 days. Perforation rates were similar in both age groups and across achalasia subtypes. Advanced age was protective of benign chest pain complications in univariate analysis, and the limited number of AEs precluded multivariable analysis. Conclusions: The safety of PD in older adults is at least comparable to that of younger patients and should be offered as an option for definitive therapy for older patients with achalasia. Our results may affect informed consent discussions. |
| first_indexed | 2024-03-10T21:09:34Z |
| format | Article |
| id | doaj.art-1beff17d64874acfb60756b780d2ec52 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:09:34Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1beff17d64874acfb60756b780d2ec522023-11-19T16:54:31ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220668210.3390/jcm12206682Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional StudyNir Bar0Christopher Vélez1Trisha S. Pasricha2Tamar Thurm3Dana Ben-Ami Shor4Roy Dekel5Yishai Ron6Kyle Staller7Braden Kuo8Gastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, IsraelCenter for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USACenter for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USAGastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, IsraelGastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, IsraelGastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, IsraelGastroenterology and Hepatology Department, Tel Aviv Medical Center, Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, IsraelCenter for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USACenter for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USABackground: Pneumatic dilation (PD) is an effective first line treatment option for many patients with achalasia. PD use may be limited in adults with achalasia who are older than 65 because of concern for adverse events (AE), and less efficacious therapies are often utilized. We explored the periprocedural safety profile of PD in older adults. Methods: An international real world cross-sectional study of patients undergoing PD between 2006–2020 in two tertiary centers. Thirty-day AEs were compared between older adults (65 and older) with achalasia and younger patients. Results: A total of 252 patients underwent 319 PDs. In 319 PDs, 18 (5.7%) complications occurred: 6 (1.9%) perforations and 12 (3.8%) emergency department referrals with benign (non-perforation) chest pain, of which 9 (2.8%) were hospitalized. No bleeding or death occurred within 30 days. Perforation rates were similar in both age groups and across achalasia subtypes. Advanced age was protective of benign chest pain complications in univariate analysis, and the limited number of AEs precluded multivariable analysis. Conclusions: The safety of PD in older adults is at least comparable to that of younger patients and should be offered as an option for definitive therapy for older patients with achalasia. Our results may affect informed consent discussions.https://www.mdpi.com/2077-0383/12/20/6682older adultsachalasiapneumatic dilationadverse eventssafety |
| spellingShingle | Nir Bar Christopher Vélez Trisha S. Pasricha Tamar Thurm Dana Ben-Ami Shor Roy Dekel Yishai Ron Kyle Staller Braden Kuo Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study Journal of Clinical Medicine older adults achalasia pneumatic dilation adverse events safety |
| title | Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study |
| title_full | Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study |
| title_fullStr | Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study |
| title_full_unstemmed | Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study |
| title_short | Safety of Pneumatic Dilation in Older Adults with Achalasia: An International Multicenter Cross-Sectional Study |
| title_sort | safety of pneumatic dilation in older adults with achalasia an international multicenter cross sectional study |
| topic | older adults achalasia pneumatic dilation adverse events safety |
| url | https://www.mdpi.com/2077-0383/12/20/6682 |
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