The esophagus after endoscopic pneumatic balloon dilatation for achalasia

The changes seen on contrast esophagrams after endoscopic pneumatic balloon dilation for the treatment of achalasia are described and illustrated. Sixteen patients had esophagrams within 24 hr after dilation and follow-up esophagrams were obtained 6-24 months later. The radiographic features evaluated in the early postdilation period included detection of esophageal perforation, diameter of the esophagogastric channel, proximal esophageal dilatation, mucosal integrity, and emptying dynamics of the esophagus. Fourteen patients (88%) had immediate symptomatic improvement of dysphagia. The mean increase in diameter of the esophagogastric channel was 6.5 mm (range, 4.8-9 mm) relative to a pretreatment esophagram. Emptying dynamics of the esophagus improved significantly in 12 patients (75%). One patient developed esophageal perforation requiring surgery. On the follow-up esophagrams obtained 6-24 months later, the evaluation was for sustained dilatation of esophagogastric channel, decrease in esophageal dilatation, and improved emptying dynamics of the esophagus. The effective esophagogastric channel diameter of 8-10 mm correlated well with improved clinical response in 88% of the patients.