ENDOSCOPIC INJECTION OF ETHANOLAMINE AS A TREATMENT FOR ACHALASIA - AFIRST REPORT

Background and Study Aims: The present study aimed to test the hypothe sis that endoscopic sclerotherapy may effectively reduce the occurrenc e of spasm at the level of the gastric cardia, offering an effective t reatment for achalasia, Patients and Methods: We prospectively treated 33 achalasia patients by repeated injection of ethanolamine oleate at the cardiac level, Twenty patients (series I) were reassessed after s ix to nine months, with a mean followup of 31.5 months (range 13-54 mo nths) after treatment, In an attempt to avoid stricture formation, the last 13 patients (series II) were then treated on the basis of the ne ed to reduce the number of injections per session and avoid new treatm ent while inflammatory or ulcerative signs, or both, were present, The series II patients were followed up for a mean of 11 months (range 1. 7-21.3 months), Results: Overall, a mean of 3.6 treatments was require d, and the result was described as ''excellent'' or ''good'' in 31 of the 33 patients after one month, Two patients had a poor response to t he treatment, but their condition improved after repeat treatment, Aft er six to nine months, the subjective parameters (dysphagia, regurgita tion, bronchopulmonary symptoms) and objective parameters (diameter of the esophagus, scintigraphy, manometry), had improved considerably af ter the treatment in the series I patients, and this improvement was s ustained for more than two years, at least by subjective criteria, Fou r of the 20 series I patients developed mild or moderate fibrotic stri ctures, but these were managed successfully by standard 15-20 mm ballo on dilation, No additional strictures were recorded in the last thirte en patients treated (series II), None of the patients who were followe d up had to undergo surgery due to failure of the treatment, Conclusio n: Endoscopic sclerotherapy appears to be a very promising alternative to the currently available therapeutic tools for achalasia.