Treatment of achalasia by pneumatic dilatation [PD]: Local experience in treating 41 patients

ABSTRACT

L'achalasia is the best known primary motor disorder of the esophagus in which the lower esophageal sphincter [LES] has abnormally high resting pressure and incomplete relaxation with swallowing. Pneumatic dilatation [PD] remains the first choice of treatment. Our aim was to report, in a retrospective way, our experience in treating with pneumatic dilatation 41 achalasia patients admitted to the gastroenterology unit at Hotel-Dieu de France [HDF] hospital between 1994 and 2004. A total of 46 dilatations were performed in 41 patients with achalasia [20 males and 21 females, the mean age was 46.8 years [range, 15-90]]. All patients underwent an initial dilatation by inflating a 35 mm balloon to 7 psi three times successively under fluoroscopic control. The need for subsequent dilatation with the same technique or for surgical treatment was based on symptom assessment. The mean follow-up period was 36.7 months [3 mo-7 years]. Among the patients whose follow-up information was available, a satisfactory result was achieved in 29 patients [805%] after only one or two sessions of pneumatic dilatation. Esophageal perforation as a short-term complication was observed in one patient [2.17%]. Seven patients were referred for surgery [one for esophageal perforation and six for persistent or recurrent symptoms]. In conclusion, performing balloon dilatation under fluoroscopic observation is simple, safe and efficacious for treating patients with achalasia. Referral to repeated PD or to surgical myotomy should be discussed in case of no response to a first session of PD