PNEUMATIC DILATION FOR ACHALASIA WITHOUT FLUOROSCOPIC GUIDANCE - SAFETY AND EFFICACY

Objectives: To describe the technique of pneumatic dilation for achala sia without fluoroscopic guidance and to assess its safety and efficac y. Methods: Twenty-seven consecutive patients who underwent pneumatic dilation with the Rigiflex achalasia balloon under direct endoscopic v isualization were reviewed. The balloon was passed into the stomach ov er a guidewire, withdrawn across the gastroesophageal junction, and di lated with the endoscope positioned proximally. Patients were graded p re- and posttreatment on the frequency of dysphagia, daytime regurgita tion, nighttime symptoms, chest pain, and heartburn. Response was asse ssed by the improvement in dysphagia frequency. Results: Twenty-seven patients (16 females, 11 males; mean age 54.0 yr) underwent 30 pneumat ic 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 o f inflation pressures was 8-18 psi (median 15 psi), and the duration o f 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 successfu l in 78% of patients after a single dilation and in 89% of patients ov erall. There were no perforations related to balloon inflation. Conclu sions: The Rigiflex balloon can be successfully positioned across the gastroesophageal junction and dilated under direct endoscopic observat ion. Pneumatic dilation for achalasia can therefore be performed simpl y, safely, and effectively without the use of fluoroscopy.