TANDEM BALLOON DILATATION FOR CHILDHOOD ACHALASIA

Background There are no previous reports of tandem balloon dilatation in childhood achalasia. Objective. To report the treatment of four cas es of paediatric achalasia using tandem balloon dilatation of the lowe r oesophageal sphincter. A review of the literature since 1986 was und ertaken to compare outcomes of balloon dilatation and surgery. Materia ls and methods. A retrospective review of the patients diagnosed with this condition and treated at our institution over the past 6 years: a ll four patients were treated by balloon dilatation of the lower oesop hageal sphincter using two or three balloons in tandem. The definition of technical success was demonstration of a waist at 1-1.5 atmosphere s of inflation pressure followed by abolition of the waist at higher p ressures. Where this was unable to be achieved using a single balloon, two or three balloons in tandem were used. Results. No patient requir ed oesophagomyotomy, and symptomatic control has been good to excellen t in three of four patients. No significant side effects were encounte red. 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 i s stretched insufficiently using a single balloon, tandem balloon dila tation should be utilised.