Rigiflex pneumatic dilation of achalasia without fluoroscopy: a novel office procedure

Ramesh, Rajagopal; Shende, Atul; Joshi, Anand; Mathur, Amit K.; Nijhawan, Sandeep

doi:10.1016/j.gie.2005.04.008

Cited by 46 publications

(25 citation statements)

References 6 publications

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“…The other mode of endoscopic therapy is ED, and the current method of choice for dilation is a controlled pneumatic dilation 63,73–75. Other older dilation methods have gradually been abandoned as they were associated with a higher perforation rate 66.…”

Section: Treatmentmentioning

confidence: 99%

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Roll

Rabl

Ciovica

et al. 2010

Journal of Gastrointestinal Surgery

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Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux.

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Section: Treatmentmentioning

confidence: 99%

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Roll

Rabl

Ciovica

et al. 2010

Journal of Gastrointestinal Surgery

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“…This balloon technique has been used without fluoroscopy to treat achalasia cardia. 9 Balloon dilation is more difficult to perform in cases of total ring slippage than in partial slippage because the GPOS is more tightened and sharply curved. Thus, patients should be treated as soon as they exhibit the first symptoms of obstruction, because these symptoms may be an indication of the onset of partial slippage.…”

Section: Discussionmentioning

confidence: 99%

Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos)

Campos

Evangelista

Ferraz

et al. 2010

Gastrointestinal Endoscopy

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“…A reduction of dysphagia in patients subjected to the above-mentioned procedure concerns 58-95% (15)(16)(17)(18)(19). The relatively low percentage of postoperative complications: mortality<1%, esophageal perforation 2-4%, reflux symptoms-5%, and low treatment costes speaks in favor of the procedure (14,(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

Kawiorski¹,

Popiela

Kibil

et al. 2007

Polish Journal of Surgery

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Esophageal achalasia, one of the most common motor activity disturbances of the upper gastrointestinal tract, continues to pose a significant diagnostic and therapeutic problem, especially in patients with milder forms of the disease. The aim of the study was to evaluate and compare treatment results (pneumatic dilatation, cardiomyotomy) in patients with esophageal achalasia, as well as determine the usefulness of intraoperative, continuous manometric monitoring of the corrected segment of the "esophagogastric junction" (evaluation of myotomy). Material and methods. The study group comprised 104 patients, including 71 female and 33 male, treated at the Department during the period between 1997 and 2004. The mean patient age was 43.5 years, ranging between 19 and 75 years. The duration of the disease ranged between 5 months and 22 years. Every patient was subjected to endoscopy, histopathological, radiological and manometric examinations, before treatment. The therapeutic model was based on a two-staged management process. During the initial stage of therapy, patients were subjected to 2-3 pneumatic dilatations. A lack of response to treatment was considered treatment failure and these patients qualified for surgery -Heller's myotomy with antireflux treatment (fundoplication). Cachectic patients requiring immediate surgical intervention were excluded from the study. Results. Following pneumatic dilatation, good or very good results were obtained in 73 (70.2%) of the 104 patients. Procedures were repeated in only 8 (11%) patients, due to the recurrence of dysphagia. The remaining 31 (29.8%) patients underwent surgery with simultaneous intraoperative manometric control of the performed myotomy. Conclusions. Based on the obtained results, one can confirm the significant efficacy of pneumatic dilatation, which is considered the ultimate therapy. In the case of patients in whom we were not able to obtain good clinical results, one observed improved esophagogastric passage, which in turn improved nutritional parameters before planned surgical intervention. Intraoperative esophageal manometry enabled us to accurately evaluate the correctness of myotomy, which seemed to be an indispensable element in the prevention of disease recurrence.

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Rigiflex pneumatic dilation of achalasia without fluoroscopy: a novel office procedure

Cited by 46 publications

References 6 publications

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos)

Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

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