Skip main navigation
Close Drawer MenuOpen Drawer Menu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Menu
  • Information
    • Previous
    Next
    Vascular and Interventional Radiology

    Balloon Dilation for Achalasia of the Cardia: Experience in 76 Patients

    Published Online:Sep 1 2002https://doi.org/10.1148/radiol.2243011049

    Abstract

    PURPOSE: To report our experience with balloon dilation for achalasia of the cardia.

    MATERIALS AND METHODS: Seventy-six patients (mean age, 51 years) underwent balloon dilation with radiologic guidance. A total of 110 procedures were performed from April 1994 to April 2000. Diagnosis of achalasia was established with clinical, radiologic, and manometric data. Dysphagia was a presenting symptom in most patients (90%), regurgitation was present in 39%, retrosternal pain in 22%, and weight loss in 12%. The dilations were performed in a progressive manner starting with a 15-mm-diameter balloon and progressing to 20-, 30-, and 40-mm balloons, as required. Follow-up data were collected retrospectively from patient notes and telephone interviews with the patients and/or their local doctors (mean follow-up, 26 months).

    RESULTS: There were no cases of esophageal perforation; 89% (98 of 110) of dilations were considered to be successful, with the patients having restoration of normal or near-normal swallowing (excellent or good initial responses). Fifty-two patients required a single dilation; 22 patients, between two and four dilations; and two patients, five dilations.

    CONCLUSION: Balloon dilation with fluoroscopic guidance is a safe and successful treatment for achalasia of the cardia.

    © RSNA, 2002

    References

    • 1 Vantrappen G, Hellemans J. Treatment of achalasia and related motor disorders. Gastroenterology 1980; 79: 144-154. Crossref, Medline, Google Scholar
    • 2 Fellows IW, Ogilvie AL, Atkinson M. Pneumatic dilatation in achalasia. Gut 1983; 24: 1020-1023. Crossref, Medline, Google Scholar
    • 3 Bennett JR, Barzaga E, Hendrix TR, et al. Treatment of achalasia by pneumatic dilatation of the cardia. Gut 1968; 9: 727. Google Scholar
    • 4 Patti MG, Pellegrini CA, Arcerito M, et al. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg 1995; 130: 609-615. Crossref, Medline, Google Scholar
    • 5 Yon J, Christensen J. An uncontrolled comparison of treatments for achalasia. Ann Surg 1975; 182: 672-676. Crossref, Medline, Google Scholar
    • 6 Katz PO, Gilbert J, Castell DO. Pneumatic dilatation is effective long-term treatment for achalasia. Dig Dis Sci 1998; 43: 1973-1977. Crossref, Medline, Google Scholar
    • 7 Kadakia SC, Wong RKH. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol 1993; 88: 34-38. Medline, Google Scholar
    • 8 Lambroza A, Schuman RW. Pneumatic dilation for achalasia without fluoroscopic guidance: safety and efficacy. Am J Gastroenterol 1995; 90: 1226-1229. Medline, Google Scholar
    • 9 Cox J, Buckton GK, Bennett JR. Balloon dilatation in achalasia: a new dilator. Gut 1986; 27: 986-989. Crossref, Medline, Google Scholar
    • 10 Metman EH, Lagasse JP, d’Alteroche L, et al. Risk factors for immediate complications after progressive pneumatic dilatation for achalasia. Am J Gastroenterol 1999; 94: 1180-1185. Google Scholar
    • 11 Barkin JS, Guelrud M, Reiner DK, et al. Forceful balloon dilation: an outpatient procedure for achalasia. Gastrointest Endosc 1990; 36: 123-126. Crossref, Medline, Google Scholar
    • 12 Csendes A, Braghetto I, Henriquez A, et al. Late results of a prospective randomised study comparing forceful dilatation and esophagomyotomy in patients with achalasia. Gut 1989; 30: 299-304. Crossref, Medline, Google Scholar
    • 13 Fried RL, Rosenberg S, Goyal R. Perforation rate in achalasia with polyethylene balloon dilators (letter). Gastrointest Endosc 1991; 37: 405. Crossref, Google Scholar
    • 14 Stark G, Castell DO, Richter JE, et al. Prospective randomized comparison of Brown-McHardy and microvasive balloon dilators in treatment of achalasia. Am J Gastroenterol 1990; 85: 1322-1325. Medline, Google Scholar
    • 15 Borotto E, Gaudric M, Danel B, et al. Risk factors for oesophageal perforation during pneumatic dilatation for achalasia. Gut 1996; 39: 9-12. Crossref, Medline, Google Scholar
    • 16 Esophageal dilation: guidelines for clinical application.Gastrointest Endosc1991; 37: 122-124. Crossref, Medline, Google Scholar
    • 17 Lobello R, Edwards DAW, Gummer JWP, et al. The antireflux mechanism after cardiomyotomy. Thorax 1978; 33: 569-573. Crossref, Medline, Google Scholar
    • 18 Black J, Vorbach AN, Collis JL. Results of Heller’s operation for achalasia of the oesophagus: the importance of hiatal repair. Br J Surg 1976; 63: 949-953. Crossref, Medline, Google Scholar
    • 19 Nair LA, Reynolds JC, Parkman HP, et al. Complications during pneumatic dilation for achalasia or diffuse esophageal spasm: analysis of risk factors, early clinical characteristics and outcome. Dig Dis Sci 1993; 38: 1893-1904. Crossref, Medline, Google Scholar
    • 20 Heimlich HJ, O’Connor TW, Flores DC. Case for pneumatic dilatation in achalasia. Ann Otol Rhinol Laryngol 1978; 87: 519-522. Crossref, Medline, Google Scholar
    • 21 Eckardt VF, Kanzler G, Westermeler T. Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow-up study. Gastrointest Endosc 1997; 45: 349-353. Crossref, Medline, Google Scholar
    • 22 Wehrmann T, Jacobi V, Jung M, et al. Pneumatic dilation in achalasia with a low-compliance balloon: results of a 5-year prospective evaluation. Gastrointest Endosc 1995; 42: 31-36. Crossref, Medline, Google Scholar
    • 23 Lishman AH, Dellipiani AW. Management of achalasia of the cardia by forced pneumatic dilatation. Gut 1982; 23: 541-544. Crossref, Medline, Google Scholar
    • 24 Nanson EM. Treatment of achalasia of the cardia. Gastroenterology 1966; 51: 236-241. Crossref, Medline, Google Scholar
    • 25 Barnett JL, Eisenmann R, Nostrant TT, et al. Witzel pneumatic dilation for achalasia: safety and long-term efficacy. Gastrointest Endosc 1990; 36: 482-485. Crossref, Medline, Google Scholar
    • 26 Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103: 1732-1738. Crossref, Medline, Google Scholar
    • 27 Vantrappen G, Hellemans J, Deloof W, et al. Treatment of achalasia with pneumatic dilatations. Gut 1971; 12: 268-275. Crossref, Medline, Google Scholar

    Article History

    Published in print: Sept 2002