Pneumatic Balloon Dilatation for Achalasia Cardia; Early & late results, a single center study

Abstract

Objective:Achalasia Cardia is treated by Pneumatic balloon dilatation, Heller’s Myotomy and recently, by Peroral Esophagaeal Myotomy. This study reports the efficacy of pneumatic balloon dilatation as a non-surgical motility in achieving relief of dysphagia, clinical improvement and recurrence. Long-term complications were reported.Methods:Eight hundred ninety two adult achalasia patients of both genders were treated from January 1988 till December 2011, with pneumatic balloon (Rigiflex Microvasive®) dilatation, under fluoroscopy Barium swallow was obtained prior to and five minutes after dilatation to evaluate for efficacy of dilatation as well as for complications. Patients not responding to 30 mm balloon had repeat dilatation with 35 mm balloon after 8 weeks. All patients were enrolled in regular follow up at one, six months and yearly intervals up to a period of five years. Recurrence was defined as an increase in symptom score at 8 weeks greater than 50% of their baseline value. These patients were treated with 35 mm balloon or referred for surgical intervention.Results:Of 892 patients, follow up was obtained in 50% for 5 years, 9.2% for 4-years), 9.3% for 3-years, 10% for 2-years and 21.5% for 1-year of patients. One patient died after repeat dilatation. Eighty-eight patients were excluded from this analysis (20 died due to non-procedure related causes and another 68 were lost during follow up). Statistically significant improvement was noted in reduction in height and width of barium column and symptom score coupled with weight gain during follow up. Forty-eight patients were subjected to repeat dilatation with 35 mm balloon, two of these developed post-procedure perforations with one mortality. Three non-responsive patients required surgical laparoscopic myotomy. No carcinoma of esophagus was reported during follow up. One patient post dilatation, developed esophageal bezoar. A single pneumatic dilatation achieved a remission rate of 93% at four years, 90% at three years, 95% at two years and 92% at one year post dilatation.Conclusion:Achalasia of esophagus can be effectively and safely treated with balloon dilatation to achieve adequate short and long-term symptomatic relief with a low complication rate.

Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Furthermore, the literature does not help determine the most appropriate timeline to resume oral intake. In the majority of publications, liquid diet was allowed 2 -8 hours after dilation [98,101,103]. We recommend that, in asymptomatic patients in whom there is no suspicion of a full-thickness tear, a soft/normal diet can be initiated on the same day or the day after the procedure.…”

Results of pneumatic dilation in treating achalasia: predictive factors

“…It has been previously shown that the initial results of forced dilatation of the cardia are effective and similar in chagasic or nonchagasic achalasia . The success rates, providing control of dysphagia for at least about 1 year from the procedure using the Rigiflex balloon, are quite satisfactory, with success in at least 75% of patients (Table ) …”

“…32 The success rates, providing control of dysphagia for at least about 1 year from the procedure using the Rigiflex balloon, are quite satisfactory, with success in at least 75% of patients (Table 2). 11,[33][34][35][36][37][38][39][40][41] This was already expressed in a review of 21 studies, where success rates reached 74%, 80%, and 90% using balloons of 30, 35, and 40 mm in diameter, respectively. 42 However, this positive view of using a larger caliber balloon for better results is diminished when it is observed in another publication that, starting with 35 mm balloons, four perforations occurred in the first 13 patients with achalasia submitted to PD, meaning that the protocol had to be adjusted so that the procedure always started with a 30-mm balloon, slowly increasing the gauge if necessary.…”

The effect of vaginal delivery and Caesarean section on the anal Sphincter complex of Primipara based on optimized three-dimensional ultrasound image and nuclear regression Reconstruction Algorithm

“…The anal sphincter is evaluated factoring into the proximal plane, the middle plane and the distal plane. [12][13][14] To use kernel regression algorithm to process the ultrasound image effectively removes the blurred image and improves the diagnosis accuracy. Compared with the traditional image, the three-dimensional image in this research was clearer.…”