PNEUMATIC DILATION IN ACHALASIA WITH A LOW-COMPLIANCE BALLOON - RESULTS OF A 5-YEAR PROSPECTIVE EVALUATION

To evaluate long-term efficacy and side effects after pneumatic dilati on with low-compliance balloons, 40 patients with achalasia were prosp ectively studied during a 5-year period. All patients were investigate d before, 4-6 weeks after, and at 28 +/- 15 months (final visit) after pneumatic dilation. Additionally, 12 patients underwent 24-hour esoph ageal pH-metry before and 26 +/- 14 months after dilation. Initial sym ptomatic success was obtained in 35 of 40 patients (87.5%). The remain ing five and another seven patients with recurrent dysphagia underwent a second dilation, and two of these patients finally underwent esopha gomyotomy. Effective dilation was reflected by a significant decrease of the symptom scores (p < 0.01) and an increase of the gastric cardia diameter both at 4-6 weeks after dilation and at the final visit (p < 0.01). Dilation reduced the lower esophageal sphincter pressure from 28.3 +/- 0.8 mmHg to 16.4 +/- 6.4 mmHg at the 4-6 weeks exam and to 14 .7 +/- 5.5 mmHg at the final visit, respectively (p < 0.01). Neither t he diameter of the esophageal body nor the motility of the tubular eso phagus was affected by pneumatic dilation. Esophageal pH-metry showed an increase of the number and duration of reflux episodes (pH < 4) aft er dilation (p < 0.05), whereas only one patient reported heartburn an d another asymptomatic patient revealed esophagitis I-0 at endoscopy. One perforation, not requiring operation, occurred. Therefore, pneumat ic dilation with low compliance balloons proved to be safe and long la sting treatment of achalasia. Although prolonged esophageal acid expos ure was measurable after dilation, clinically relevant gastroesophagea l reflux occurred in only 5% (n = 2).