Technique for pneumatic dilatation in achalasia complicated by "sigmoid" esophagus

The endoscopic passage of a guidewire to facilitate the placement of a pneumatic dilator is not widely practiced. We describe a patient with achalasia in whom marked "sigmoid" deformity of the distal esophagus prevented the placement of a dilator by the standard technique. Correct positioning was easily achieved by using a fiberoptic endoscope to pass a guidewire into the stomach. The pneumatic dilator with internal stiffener was attached to the guidewire and positioned fluoroscopically at the gastroesophageal junction. A clinically successful dilatation was then achieved.