Patients who have been treated for achalasia and present with symptom recurrence should be carefully evaluated for potential development of oesophageal cancer prior to considering reintervention, the authors of a new study caution.
In the study of 7487 patients in England diagnosed with oesophageal achalasia and receiving a treatment between 2002 and 2012, multiple reinterventions following primary achalasia treatment with either surgical myotomy or pneumatic dilation emerged as a risk factor for oesophageal cancer.
The incidence of oesophageal cancer for the study cohort was 205 cases per 100,000 patient years at risk. Patients who developed oesophageal cancer were older and were more likely to have been primarily treated with pneumatic dilation (82.2 vs 60.3%; P<.001).
In the oesophageal cancer group, there was an increase in the number of patients requiring reinterventions (47.5 vs 38.0%; P=.041) and the average total number of reinterventions per patient (1.2 vs 0.8; P=.026).
Multivariate analysis suggested associations between increased reintervention following both surgical myotomy (HR, 5.1; 95% CI, 1.12-23.16) and pneumatic dilation (HR, 1.48; 95% CI, 0.95-2.29) and oesophageal cancer risk.
Based on the findings, the authors advise that “treated achalasia patients with symptom recurrence should be carefully evaluated for potential development of oesophageal cancer prior to considering reintervention, and increased vigilance may help diagnose oesophageal cancer in these individuals at an early stage.”
