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

Abstract

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.

Endoscopic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up

“…Poor esophageal emptying occurred in about 30% of patients who reported complete relief of symptoms after PD, 90% of whom experienced a recurrence in the first year 8 . In our study, just one session of PD was clinically effective for 85% of the patients, as described in the vast majority of studies which report around 80%, 9–11 with therapeutic effectiveness similar to that of patients who undergo surgery 12,13 . In our research work, the effective clinical response was corroborated by a significant reduction in the esophageal diameter and an increase in the inner diameter of the cardia.…”

“…8 In our study, just one session of PD was clinically effective for 85% of the patients, as described in the vast majority of studies which report around 80%, [9][10][11] with therapeutic effectiveness similar to that of patients who undergo surgery. 12,13 In our research work, the effective clinical response was corroborated by a significant reduction in the esophageal diameter and an increase in the inner diameter of the cardia. A decrease rate of 50% in the LES pressure, 14 or under 17 mm Hg, 15 is considered sufficient to improve the symptoms significantly without increasing the risk of complications, such as GER; in our study, the mean LES pressure decreased from 35.2 to 17.8 mm Hg (a decrease rate of 49%).…”

Neurogastroenterology and motility around the world

“…At the clinical level, the long‐term evolution of chagasic megaesophagus was assessed in one center, 15 while the results of the surgical treatment of chagasic achalasia has been examined in a multicentric study in Brazil, 16 and those for pneumatic dilation have been assessed in Argentina 17 . The results of the surgical treatment of megacolon have also been assessed at the University of Sao Paulo Faculty of Medicine in Sao Paulo City 18 …”

Levels of muscle enzymes in the serum after esophageal pneumatic dilation in patients with achalasia

“…CK is also active in smooth muscle, such as in the esophagus 3 . Pneumatic dilation of the esophagus is one of the therapeutic interventions available in patients with achalasia, but the success rate of this procedure is variable 4,5 …”

“…3 Pneumatic dilation of the esophagus is one of the therapeutic interventions available in patients with achalasia, but the success rate of this procedure is variable. 4,5 We have found only one study published on the levels of enzymes after invasive therapy for esophageal disorders. In this study, a modest increase in CK and lactic dehydrogenase (LDH) levels was described in five patients after esophageal dilation.…”