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Tandem balloon dilatation for childhood achalasia
P D Hammond1, D J Moore, G P Davidson
1Child Health Research Institute and Gastroenterology Unit, Women's and Children's Hospital, King William Road, North Adelaide 5006, Australia.
Insights
Tandem balloon dilatation is a novel treatment for childhood achalasia, offering good to excellent symptom control with low morbidity. This procedure should be considered a first-line therapy for pediatric achalasia.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Achalasia is a rare esophageal motility disorder in children.
- Tandem balloon dilatation of the lower esophageal sphincter (LES) has not been previously reported in pediatric achalasia cases.
Purpose of the Study:
- To report the efficacy of tandem balloon dilatation for treating pediatric achalasia.
- To compare outcomes of balloon dilatation versus surgery for pediatric achalasia.
Main Methods:
- Retrospective review of four pediatric achalasia patients treated with tandem balloon dilatation (2-3 balloons).
- Technical success defined by LES "waist" abolition during inflation.
- Literature review of balloon dilatation and surgical outcomes since 1986.
Main Results:
- Successful symptomatic control in three of four patients.
- No patients required esophagomyotomy.
- No significant adverse events were reported.
Conclusions:
- Tandem balloon dilatation is a safe and effective treatment for pediatric achalasia.
- Balloon dilatation and surgery demonstrate comparable success rates in pediatric achalasia.
- Tandem balloon dilatation is recommended when single balloon dilation is insufficient.
Background:
There are no previous reports of tandem balloon dilatation in childhood achalasia.
Objective:
To report the treatment of four cases of paediatric achalasia using tandem balloon dilatation of the lower oesophageal sphincter. A review of the literature since 1986 was undertaken to compare outcomes of balloon dilatation and surgery.
Materials And Methods:
A retrospective review of the patients diagnosed with this condition and treated at our institution over the past 6 years: all four patients were treated by balloon dilatation of the lower oesophageal sphincter using two or three balloons in tandem. The definition of technical success was demonstration of a waist at 1-1.5 atmospheres of inflation pressure followed by abolition of the waist at higher pressures. Where this was unable to be achieved using a single balloon, two or three balloons in tandem were used.
Results:
No patient required oesophagomyotomy, and symptomatic control has been good to excellent in three of four patients. No significant side effects were encountered.
Conclusions:
Balloon dilatation and surgery have similar success rates in paediatric achalasia. Because of the low morbidity associated with balloon dilatation, the procedure should be considered as first line treatment of this condition. If the lower oesophageal sphincter is stretched insufficiently using a single balloon, tandem balloon dilatation should be utilised.