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

Abstract

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.

Comparison of temporary stent insertion with pneumatic dilation of the same diameter in the treatment of achalasia patients: A retrospective study

“…A timed barium esophagram was performed as an objective assessment of improvement in esophageal emptying in all treated patients 2,8 . Before the examination, patients were asked to fast overnight prior to the test.…”

“…Pneumatic dilatation in patients with esophageal achalasia is generally considered to be the first‐choice procedure 1–3 . The effective disruption of circular muscle fibers of the lower esophageal sphincter (LES) is the theoretical basis for the benefits associated with balloon dilatation 2 . However, recently, retrievable, covered stent placement has been involved as a potential effective method to treat esophageal achalasia 4–7 .…”

The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia

“…The techniques used for pneumatic dilatation depend on the centre, with variations in the type of instruments, balloon size, timing of dilatation, and frequency of dilatation. Despite all of the possible permutations, estimates of the likelihood of success and complications are remarkably stable [6,10,14,24,31,32,37,39]. Therefore, for the purposes of this analysis we assumed that the method of dilatation was inconsequential, and pooled all methods to form the probability estimates.…”

Review article: the management of achalasia – a comparison of different treatment modalities1

“…Multiple large series and reviews show a perforation rate of <1-3%. 18,38,[51][52][53] It has been noted that the risk of perforation is greatest on the initial dilatation as opposed to subsequent dilatations. 52,53 Evaluation of predictive factors for perforation revealed that high distal oesophageal contraction amplitudes (>70 cm H 2 O) were more predominant in those with subsequent perforation.…”