Pneumatic Balloon Dilation in Achalasia: A Prospective Comparison of Balloon Distention Time

Khan, Abdul Wali; Shah, S. W. H.; Alam, Altaf; Butt, Arshad Kamal; Shafqat, Farzana; Castell, Donald O.

doi:10.1111/j.1572-0241.1998.00330.x

Cited by 56 publications

(25 citation statements)

References 6 publications

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“…2 Until now, this variability was attributed to differences in dilation technique; however, recent reports indicate that differences in techniques (that is, balloon distention time) do not affect symptomatic outcome. 10 As prior studies used symptom improvement post therapy as the primary measure of success, we speculate that a portion of these failures after pneumatic dilation represent the subset of patients with improved symptoms but continued poor oesophageal emptying. As our study indicates, symptom assessment alone may not be the optimum method of following achalasia patients post pneumatic dilation.…”

Section: Discussionmentioning

confidence: 86%

Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment

Vaezi

2002

Gut

261

197

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Background: Symptom relief post pneumatic dilation is traditionally used to assess treatment success in achalasia patients. Recently, we showed that symptom relief and objective oesophageal emptying are concordant in about 70% of patients, while up to 30% of achalasia patients report near complete symptom relief despite poor oesophageal emptying of barium. Aims: We now report the results of long term clinical follow up in these two groups of achalasia patients, assessing differences in symptomatic remission rates. Methods: Achalasia patients undergoing pneumatic dilation since 1995 were evaluated both symptomatically and objectively at regular intervals. Pre and post dilation symptoms were recorded. Barium column height was measured five minutes after ingesting a fixed volume of barium per patient to assess oesophageal emptying. Patients who initially reported near complete symptom relief were divided into two groups based on objective findings on barium study: (1) complete oesophageal emptying (concordant group), and (2) poor oesophageal emptying (discordant group). Patients were followed prospectively for symptom recurrence. Results: Thirty four patients with complete symptom relief post pneumatic dilation were identified. In 22/34 (65%) patients, the degree of symptom and barium height improvements was similar (concordant group). In 10/34 (30%) patients, there was < 50% improvement in barium height (discordant group). Significantly (p<0.001) more discordant (9/10; 90%) than concordant (2/22; 9%) patients failed therapy at the one year follow up. Seventeen of 22 (77%) concordant patients were still in remission while all discordant patients had failed therapy by six years of follow up. Length of time in symptom remission (mean (SEM)) post pneumatic dilation was significantly (p=0.001) less for the discordant group (18.0 (3.6) months) compared with the concordant group (59.0 (4.8) months). Conclusions: (1) Poor oesophageal emptying is present in nearly 30% of achalasia patients reporting complete symptom relief post pneumatic dilation. (2) The majority (90%) of these patients will fail within one year of treatment. (3) Timed barium oesophagram is an important tool in the objective evaluation of achalasia patients post pneumatic dilation.

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Section: Discussionmentioning

confidence: 86%

Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment

Vaezi

2002

Gut

261

197

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“…As for the dilation technique, no significant differences were observed between distention times of 30 s and 60 s. Likewise, some reports have shown that different dilator sizes (3.5 or 4 cm diameter) do not have a significant impact on PD results 19,20 . On the other hand, other studies found an association between symptomatic relief and dilator size 21–25 .…”

Section: Discussionmentioning

confidence: 87%

Pneumatic dilatation in achalasia of the esophagus: a report from Argentina

Salis

Mazzadi

García

et al. 2004

Diseases of the Esophagus

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We review the treatment of esophageal achalasia by means of pneumatic dilatation (PD), analyzing its results and comparing them with those of the literature. We conclude that our personal experience is similar to that of the literature: PD and surgery produce similar results (67-95%), morbidity (2-9.5%), and mortality (0.7-1%); and PD is cheaper than surgery. According to these conclusions, we believe that the decision of the appropriate treatment should be based on a combination of the choice of the properly informed patient and the operator's experience. However, we also conclude that surgery is mandatory in selected cases, such as achalasia associated with hiatus hernia, esophageal diverticula and neoplasia, history of previous PD failure (since in our experience the results after a second PD are very poor), postoperative relapse, and patients with grade IV mega-esophagus according to Resano-Malenchini's classification.

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“…At the initial dilatation, the 3.0 cm balloon, inflated for short periods (6-15 seconds), appears as effective as larger balloons inflated for longer durations. [30][31][32] 6.5 Monitoring during the procedure The patient's clinical condition should be observed throughout the procedure by both the endoscopist and nursing staff. Supplemental oxygen and pulse oximetry should be used routinely as dilatation is frequently performed in high risk patients, is occasionally prolonged, and some patients require both opioids and benzodiazepines.…”

Section: Achalasia Dilatationmentioning

confidence: 99%

Guidelines on the use of oesophageal dilatation in clinical practice

Riley

Attwood²

2004

Gut

101

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Pneumatic Balloon Dilation in Achalasia: A Prospective Comparison of Balloon Distention Time

Abstract: Short duration of pneumatic balloon dilatation (6-s) is as effective as longer duration (60-s) in treatment of achalasia.

Cited by 56 publications

References 6 publications

Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment

Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment

Pneumatic dilatation in achalasia of the esophagus: a report from Argentina

Guidelines on the use of oesophageal dilatation in clinical practice

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