Achalasia Dilation
Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future.
Pneumatic Dilation
Pneumatic dilation is an endoscopic therapy for achalasia. An air-filled cylinder-shaped balloon disrupts the muscle fibers of the lower esophageal sphincter, which is too tight in patients with achalasia.
FAQ
A. During an outpatient upper endoscopy, the endoscopist passes a catheter with a deflated balloon through the mouth and into the stomach. The balloon is centered over the lower esophageal sphincter and inflated with air. The pneumatic dilating balloon used to treat achalasia is 30 to 40 mm (about 1.2 to 1.6 inches) in diameter. The standard dilator used to treat other causes of difficulty swallowing has a maximum diameter of 20 mm (about 0.75 inch). If symptoms do not improve adequately with the first dilation, a second or third procedure may be performed at a later date with a larger dilator. Pneumatic dilation is often performed with X-ray guidance, although it can be performed using EndoFLIP, without X-ray guidance.
A. Patients with difficulty swallowing due to achalasia may be treated with pneumatic dilation. Alternative treatments include peroral endoscopic myotomy (POEM), Heller myotomy (a traditional surgery), and botulinum toxin (Botox®) injection.
A. Pneumatic dilation is generally a safe procedure. Rare complications include bleeding and a puncture (or perforation) in the lining of the esophagus. If you notice blood in your stool, black stool, fever, chills, vomiting, chest pain, stomach pain, or shortness of breath, contact your doctor as instructed on your discharge papers.
A. Preparation for pneumatic dilation is similar to preparation for upper endoscopy, except you should limit your diet to liquids for at least 24 hours before the procedure. You must have a licensed driver who is 18 years or older accompany you to your appointment and drive you home, as the sedatives or anesthesia will make you drowsy.
A. After the pneumatic dilation procedure, you will be taken to a recovery room where your driver can join you. The doctor who performed the procedure will explain the preliminary results to you. You will receive detailed recommendations for diet, medicines, and follow-up. The results of the procedure will be communicated to your referring physician(s).