Results of pneumatic dilation in treating achalasia: predictive factors

Abstract

Forced pneumatic dilatation (PD) of the cardia is one of the most consecrated therapeutic measures for esophageal achalasia. The procedure only achieved better standardization with the appearance of the Rigiflex balloon. Results and predictive factors of success and failure of PD are reviewed, right after the description of the main technical aspects of the procedure. The success rates, providing control of dysphagia for about 1 year from the procedure using the Rigiflex balloon, are quite satisfactory, with success in more than 75% of patients. It is generally observed that good responses sustained for more than 5 years appear in at least 40% of cases. However, approximately half of the patients submitted to PD require additional dilation and a subgroup of them will undergo surgical treatment to attain adequate control of dysphagia. PD is a method with a low rate of acute complications, with esophageal perforation, the most severe of them, not affecting more than 5% of the cases. The best results could be potentially obtained when predictive factors of success were considered before choosing PD as a therapeutic option, but prospective studies in this field are missing until now.

Optional Management of Achalasia in 2021: Dilatation or Myotomy

“…The preprocedure predictors for poor response to PD include young age (≤ 40 years), male gender, high-baseline LES pressure (> 50 mm Hg), dilated esophagus (> 3 cm) and type III achalasia. 17,18 Postdilatation predictive factors for relapse after PD include incomplete barium emptying (< 50%) and postdilatation LES pressure > 10 mm Hg or < 50% reduction in the LES pressure. 18 Of these, young age (< 40 years) and Fig.…”

“…17,18 Postdilatation predictive factors for relapse after PD include incomplete barium emptying (< 50%) and postdilatation LES pressure > 10 mm Hg or < 50% reduction in the LES pressure. 18 Of these, young age (< 40 years) and Fig. 1 Outcome of pneumatic dilatation according to the protocol (single vs graded vs graded plus on-demand dilatation).…”

Achalasia: treatment, current status and future advances

“…The balloons are typically 30 or 35 mm in diameter, with most current protocols calling for dilation with the 30-mm balloon followed by the 35-mm balloon if adequate results are not obtained [15]. Early results are good, with 70% of patients experiencing a substantial relief of dysphagia at 6 months after a mean of two dilation episodes [16]. However, late-term follow-up has documented decreasing success over time, with only 36% of patients still having dysphagia relief after 20 years [17].…”

Endoscopic clipping of a complicated esophageal perforation following pneumatic dilation for achalasia: A case study and literature review

“…Being followed by a significant decrease in LES pressure, PBD has shown to be associated with a remarkable resolution of achalasia symptoms. In <5% of cases, however, PBD leads to esophageal perforation—a complication linked to severe morbidity 1 . This complication could be managed with a wide variety of options, including conservative management 2,3 and surgical interventions 4,5 .…”