Balloon dilatation of cradiac achalasia in children

ABSTRACT

Surgical treatment of cardiac achalasia in children is still the main line of treatment with a success rate of 70-80%. Balloon dilatation is less widely used due to inappropriate size of balloons. The authors report their experience in 11 children with cardiac achalasia over the last 3 years using balloon dilatation as the first line of treatment. There were 8 boys and 3 girls -with ages ranging from 1.5-14 years [average 7.5 years]. One family presented to us [brother and sister] but with no glucocorticoid deficiency or other anomalies, one patient had mental retardation otherwise the rest had no associated anomalies.All Patients presented with vomiting, 7 with dysphagia, 6 with loss of weight, 5 with recurrent chest infection and 2 with retrostenal pain. Radiological diagnosis was accurate in all patients, endoscopy with biopsy were done to confirm diagnosis and exclude other pathology, manometry was confirmative in 4 patients. Dilatation was done under fluoroscopic control, balloons were used over a guide wire [balloon size were 18-35 mm]. Seven patients had 2 sessions and 4 had 3 sessions with radiological follow up after the second dilatation. Follow up ranged from 6 months to 3 years excellent results were achieved in 8 pateints [72.7%] with disappearance of symptoms and marked radiological improvment, 2 still have mild symptoms with over all success of [90.9%] one has mild gastroesphageal reflux controlled medically and one has mild dysphagia but better than before dilatation. One pateint had recurrent dysphagia necessitating cardiomyotomy [9.1%]. Results were not related to age and sex. the authors recommend balloon dilatation in children with achalasia as the first line if not the definitive line of treatment