Achalasia

Vantrappen, Gaston; Hellemans, J.

doi:10.1007/978-3-642-86429-2_14

Cited by 14 publications

(13 citation statements)

References 145 publications

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“…A 30‐mm balloon was used initially in all patients and on follow up, if there was recurrence of disturbing dysphagia and less than 50% reduction in composite symptom score, dilatation was repeated with a larger, balloon size of 35 mm. Using a larger balloon carries certain risks, including hemorrhage, severe substernal pain, and esophageal perforation near the cardia, as reported earlier 11 . In our series of 300 patients, esophageal perforation was noted in two patients with the 35‐mm balloon, diagnosed immediately on barium swallow, one patient died despite early surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Sixteen years follow up of achalasia: a prospective study of graded dilatation using Rigiflex balloon

Khan¹,

Shah²,

Alam³

et al. 2005

Diseases of the Esophagus

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Pneumatic balloon dilatation is the treatment of choice for esophageal achalasia. Rigiflex (Microvasive, Watertown, MA) polyethylene balloon dilators have been used with varying success and complications. The aim of this study was to evaluate the efficacy of graded balloon dilatation, to achieve symptomatic improvement in patients with achalasia. From January 1987 until the end of December 2003, 300 patients were evaluated and treated for achalasia, with 30 mm balloons. Patients who did not achieve satisfactory symptomatic responses during follow up underwent repeat dilatation with 35-mm balloons. They were studied at the onset then at 1 and 6 month intervals and then yearly for postdilatation symptom evaluation for dysphagia, regurgitation, night cough and heartburn. Baseline and 5-min postdilatation barium swallow studies were obtained to compare barium height and width for efficacy of dilatation and to evaluate for complications. No patients developed cancer of the esophagus in 16 years follow up. Barium height, width, composite symptom score and weight improved significantly during follow up. Two patients, who needed repeat dilatation with 35-mm balloons, developed esophageal perforation; one was successfully managed with intensive medical care management, whereas the other patient died despite surgical intervention. The authors conclude that pneumatic balloon (Rigiflex) dilatation for achalasia of the esophagus is a successful first option, when applied in an incremental balloon size to achieve desired results in symptomatic relief.

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Section: Discussionmentioning

confidence: 99%

Sixteen years follow up of achalasia: a prospective study of graded dilatation using Rigiflex balloon

Khan¹,

Shah²,

Alam³

et al. 2005

Diseases of the Esophagus

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“…The diagnosis of achalasia was substantiated by radiological, endoscopic, and manometric criteria 5. Patients met the following entry criteria: absence of diabetes mellitus, alcoholism, collagen vascular disorders, or neurological disease; no previous history of oesophageal, gastric, biliary, or oncological surgery; and no previous endoscopic or surgical treatment of their achalasia.…”

Section: Methodsmentioning

confidence: 99%

“…There are, however, several disorders that may mimic idiopathic achalasia, Chagas’ disease and oesophagogastric carcinoma being the most important 34 Typical manometric findings in achalasia include both an abnormal relaxation pattern of the lower oesophageal sphincter (LOS), and disturbed oesophageal peristalsis 5. These abnormalities are probably responsible for the delayed oesophageal clearance observed in these patients 6.…”

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confidence: 99%

Oesophageal tone in patients with achalasia

González

Mearin

Vásconez

et al. 1997

Gut

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Background-The diagnosis and classification of oesophageal motility disorders is currently based on assessment of the phasic contractile activity of the oesophagus. Tonic muscular contraction of the oesophageal body (oesophageal tone) has not been well characterised. Aim-To quantify oesophageal tonic activity in healthy subjects and in patients with achalasia. Patients-Oesophageal tone was measured in 14 patients with untreated achalasia and in 14 healthy subjects. In eight patients with achalasia, oesophageal tone was again measured one month after either endoscopic or surgical treatment. Methods-Tonic wall activity was quantified by means of a flaccid intraoesophageal bag, 5 cm long and of 120 ml maximal capacity, which was placed and maintained 5 cm above the lower oesophageal sphincter and connected to an external electronic barostat. The experimental design included measurement of oesophageal basal tone and compliance as well as the oesophageal tone response to a nitric oxide donor (0.5 ml amyl nitrite inhalation). Results-Oesophageal basal tone, expressed as the intrabag (intraoesophageal) volume at a minimal distending pressure (2 mm Hg), did not diVer significantly between patients with achalasia and healthy controls (6.6 (2.5) ml versus 4.1 (0.8) ml, respectively). Oesophageal compliance (volume/pressure relation during intraoesophageal distension) was significantly increased in achalasia (oesophageal extension ratio: 3.2 (0.4) ml/mm Hg versus 1.9 (0.2) ml/mm Hg; p< 0.01). Amyl nitrite inhalation induced oesophageal relaxation both in patients and in controls, but the magnitude of relaxation was greater in the latter (intrabag volume increase: 15.3 (2.4) ml versus 36.2 (7.1) ml; p<0.01). Conclusion-In patients with achalasia, oesophageal tonic activity, and not only phasic activity, is impaired. Although oesophageal compliance is increased, residual oesophageal tone is maintained so that a significant relaxant response may occur after pharmacological stimulation. (Gut 1997; 41: 291-296)

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“…In order to optimize the treatment of achalasia by PD, several studies seek to determine factors that can predict its clinical results. Thus, patients of more advanced age, female, and with a moderately dilated esophagus (less than 3 cm in diameter), and a long history of dysphagia appear to be more favorable candidates for success …”

Section: Predictive Factors Of Success and Failurementioning

confidence: 99%

Results of pneumatic dilation in treating achalasia: predictive factors

Felix

2018

Annals of the New York Academy of Sciences

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Forced pneumatic dilatation (PD) of the cardia is one of the most consecrated therapeutic measures for esophageal achalasia. The procedure only achieved better standardization with the appearance of the Rigiflex balloon. Results and predictive factors of success and failure of PD are reviewed, right after the description of the main technical aspects of the procedure. The success rates, providing control of dysphagia for about 1 year from the procedure using the Rigiflex balloon, are quite satisfactory, with success in more than 75% of patients. It is generally observed that good responses sustained for more than 5 years appear in at least 40% of cases. However, approximately half of the patients submitted to PD require additional dilation and a subgroup of them will undergo surgical treatment to attain adequate control of dysphagia. PD is a method with a low rate of acute complications, with esophageal perforation, the most severe of them, not affecting more than 5% of the cases. The best results could be potentially obtained when predictive factors of success were considered before choosing PD as a therapeutic option, but prospective studies in this field are missing until now.

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Achalasia

Cited by 14 publications

References 145 publications

Sixteen years follow up of achalasia: a prospective study of graded dilatation using Rigiflex balloon

Sixteen years follow up of achalasia: a prospective study of graded dilatation using Rigiflex balloon

Oesophageal tone in patients with achalasia

Results of pneumatic dilation in treating achalasia: predictive factors

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