Therapeutic Value of the Pneumatic Dilator in Achalasia of the Esophagus

Kurlander, Donald J.; Raskin, Howard F.; Kirsner, Joseph B.; Palmer, Walter L.

doi:10.1016/s0016-5085(19)34822-x

Cited by 56 publications

(9 citation statements)

References 11 publications

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“…Eleven patients (3.6%) reported short‐lived benefits from single dilatation with small (30 mm) balloons and required repeat dilatation with 35‐mm balloons to relieve their symptoms. The results of our study are in agreement with those of previously published studies, which reported success rates of 65–69% with a single dilatation increasing to 77% after repeat dilatation 7–9 …”

Section: Discussionsupporting

confidence: 93%

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

Khan¹,

Shah²,

Alam³

et al. 2005

Diseases of the Esophagus

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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.

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Section: Discussionsupporting

confidence: 93%

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

Khan¹,

Shah²,

Alam³

et al. 2005

Diseases of the Esophagus

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“…Gastro-oesophageal reflux and peptic oesophagitis seem to be more of a problem after Heller's operation than after forceful dilatations. Troublesome heart-burn or stenosing oesophagitis is not or rarely observed in patients treated by forceful dilatations (Kurlander, Raskin, Kirsner, and Palmer, 1963). Bennett, Barzaga, Hendrix, and Siegal (1968) considered that gastrooesophageal reflux was the cause of a poor result in two of their 51 patients treated with the Hurst-Tucker pneumatic dilator.…”

Section: Discussionmentioning

confidence: 99%

Treatment of achalasia with pneumatic dilatations

Vantrappen¹,

Hellemans²,

Deloof³

et al. 1971

Gut

195

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SUMMARY During the last 13 years 264 unselected patients with achalasia have been treated solely by the technique of pneumatic dilatation. The principle of the method was to continue the series of consecutive dilatations until the result was satisfactory. This paper reports the late results in 138 patients who were treated more than three years ago (3-13 years; mean 6.6 years). The results were evaluated by somebody who had not before been involved in the treatment of achalasia. The evaluation was based on a personal interview, a standardized radiological examination, and intraluminal pressure measurements.These late results were classified as excellent in 45 %, good in 32%, moderate in 17%, and poor in 6 %. The best results were obtained in patients with a history of five to twenty years and a moderately dilated oesophagus (50-80 mm.). Comparison of the clinical results with the manometric data obtained before, immediately after, and late after treatment indicates that intraluminal pressure measurements may be a useful guide for the treatment of achalasia by pneumatic dilatations.

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“…Reported balloon inflation pressures range from 360 mmHg (7 psi) to 775 mmHg (15 psi) with periods of inflation ranging from several seconds to 5 min [113]. Dilation with an endoscope or with standard bougies (up to 60F) provides very temporary benefit at best.…”

Section: Pneumatic Dilationmentioning

confidence: 99%