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Utility of parameters measured during pneumatic dilation as predictors of successful dilation
1Department of Medicine, Walter Reed Army Medical Center, Washington, D.C. 20305-5001, USA.
Objectives:
The ability to immediately predict the long term outcome of a pneumatic dilation in achalasia has not been well studied. This study prospectively compared immediate postpneumatic dilation parameters with long term efficacy to determine if any factors predicted a favorable long term outcome.
Methods:
Twenty-nine previously undilated achalasia patients underwent graduated pneumatic dilation with Hurst-Tucker dilators (diameters 2.7, 3.3, 3.7, and 4.1 cm). Dilations began with the smallest dilator followed by an observation period of at least 6 wk to determine clinical response. If no clinical improvement was noted, the next size dilator was used. Immediate postdilation parameters studies included: 1) severity of pain during dilation, 2) amount of blood on the dilator, 3) insufflation pressures during dilation, 4) esophageal emptying of gastrograffin (30 ml), and 5) esophageal emptying of barium sulfate (90 ml).
Results:
None of the postdilation parameters studied predicted which patients would have good long term results. Pain during dilation increased with increasing dilator size.
Conclusions:
The degree of pain associated with a pneumatic dilation, the amount of blood noted on the dilator, the difference in pressure required to inflate the dilator at the beginning versus the end of dilation, and the amount of esophageal emptying immediately postdilation did not predict long term outcome.