Pneumatic dilation for achalasia without fluoroscopic guidance: safety and efficacy

To describe the technique of pneumatic dilation for achalasia without fluoroscopic guidance and to assess its safety and efficacy.

Twenty-seven consecutive patients who underwent pneumatic dilation with the Rigiflex achalasia balloon under direct endoscopic visualization were reviewed. The balloon was passed into the stomach over a guidewire, withdrawn across the gastroesophageal junction, and dilated with the endoscope positioned proximally. Patients were graded pre- and posttreatment on the frequency of dysphagia, daytime regurgitation, nighttime symptoms, chest pain, and heartburn. Response was assessed by the improvement in dysphagia frequency.

Twenty-seven patients (16 females, 11 males; mean age 54.0 yr) underwent 30 pneumatic dilations. The 30-mm balloon was used in most cases (67%). The mean postdilation follow-up was 21.1 months (1.5-57.4 months). The range of inflation pressures was 8-18 psi (median 15 psi), and the duration of inflation was 30-120 s (median 90 s). Eighteen of 27 patients (67%) had excellent or good results, six (22%) had fair results, and three (11%) had poor results. The outcome of pneumatic dilation was successful in 78% of patients after a single dilation and in 89% of patients overall. There were no perforations related to balloon inflation.

The Rigiflex balloon can be successfully positioned across the gastroesophageal junction and dilated under direct endoscopic observation. Pneumatic dilation for achalasia can therefore be performed simply, safely, and effectively without the use of fluoroscopy.