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Semin intervent Radiol 2004; 21(3): 149-155
DOI: 10.1055/s-2004-860873
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Balloon Dilatation of Esophageal Strictures/Achalasia

Tarun Sabharwal1 , 2 , Andreas Adam2
  • 1Consultant Radiologist, Guy's and St Thomas' Hospital, London, United Kingdom
  • 2Department of Interventional Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
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Publication History

Publication Date:
16 December 2004 (online)

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ABSTRACT

Achalasia is an esophageal motor disorder characterized by increased lower esophageal sphincter (LES) pressure, diminished-to-absent peristalsis in the distal portion of the esophagus composed of smooth muscle, and lack of a coordinated LES relaxation in response to swallowing. These abnormalities are recognized radiographically by aperistalsis, esophageal dilatation, and decreased opening of the LES, with a characteristic “bird-beak” appearance. The principal symptom of this disorder is dysphagia and pneumatic dilatation is designed to alleviate or cure this symptom.

KEYWORDS

Achalasia - balloon dilatation - fluoroscopy - dysphagia

REFERENCES

  • 1 Vantrappen G, Hellemans J. Treatment of achalasia and related motor disorders.  Gastroenterology. 1980;  79 144-154
    PubMedGoogle Scholar
  • 2 Patti M. Achalasia. Emedicine. Available at: http://www.emedicine.com/med/topic16.htm. Accessed August 2003
    Google Scholar
  • 3 Mayberry J F, Rhodes J. Achalasia in the city of Cardiff from 1926 to 1977.  Digestion. 1980;  20 248-252
    PubMedGoogle Scholar
  • 4 Mayberry J F, Atkinson M. Studies of incidence and prevalence of achalasia in the Nottingham area.  Q J Med. 1985;  56 451-456
    PubMedGoogle Scholar
  • 5 Nihoul-Fekete C, Bawab F, Lortat-Jacob S, Arhan P. Achalasia of the esophagus in childhood. Surgical treatment in 35 cases, with special reference to familial cases and glucocorticoid deficiency association.  Hepatogastroenterology. 1991;  38 510-513
    PubMedGoogle Scholar
  • 6 Lind C D. Dysphagia: evaluation and treatment.  Gastroenterol Clin North Am. 2003;  32 553-575
    CrossrefPubMedGoogle Scholar
  • 7 Fellows I W, Ogilvie A L, Atkinson M. Pneumatic dilatation in achalasia.  Gut. 1983;  24 1020-1023
    PubMedGoogle Scholar
  • 8 Bennett J R, Bargaza E, Hendrix T R, Siegel C I. Treatment of achalasia by pneumatic dilatation of the cardia.  Gut. 1968;  9 727
    PubMedGoogle Scholar
  • 9 Patti M G, Pellegrini C A, Arcerito M et al.. Comparison of medical and minimally invasive surgical therapy for primary oesophageal motility disorders.  Arch Surg. 1995;  130 609-615
    CrossrefPubMedGoogle Scholar
  • 10 Yon J, Christensen J. An uncontrolled comparison of treatments for achalasia.  Ann Surg. 1975;  182 672-676
    PubMedGoogle Scholar
  • 11 Katz P O, Gilbert J, Castell D O. Pneumatic dilatation is effective long-term treatment for achalasia.  Dig Dis Sci. 1998;  43 1973-1977
    CrossrefPubMedGoogle Scholar
  • 12 Kadakia S C, Wong R KH. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary oesophageal achalasia.  Am J Gastroenterol. 1993;  88 34-38
    PubMedGoogle Scholar
  • 13 Lambroza A, Schuman R W. Pneumatic dilation for achalasia without fluoroscopic guidance: safety and efficacy.  Am J Gastroenterol. 1995;  90 1226-1229
    PubMedGoogle Scholar
  • 14 Cox J, Buckton G K, Bennett J R. Balloon dilatation in achalasia: a new dilator.  Gut. 1986;  27 986-989
    PubMedGoogle Scholar
  • 15 Sabharwal T, Cowling M, Dussek J et al.. Balloon dilation for achalasia of the cardia: experience in 76 patients.  Radiology. 2002;  224 719-724
    PubMedGoogle Scholar
  • 16 Sabharwal T, Cowling M, Dussek J et al.. Balloon dilation for achalasia of the cardia: a day case procedure.  Radiology. 2003;  228 594
    PubMedGoogle Scholar
  • 17 Uthappa M C, Uberoi J, Phillip-Hughes J, Boardman P. Balloon dilation for achalasia of the cardia: a day case procedure.  Radiology. 2003;  228 594
    PubMedGoogle Scholar
  • 18 Eckardt V F, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation.  Gastroenterology. 1992;  103 1732-1738
    CrossrefPubMedGoogle Scholar
  • 19 Vaezi M F, Baker M E, Achkar E et al.. Timed barium oesophagram: better predictor of long-term success after pneumatic dilation in achalasia than symptom assessment.  Gut. 2002;  50 765-770
    CrossrefPubMedGoogle Scholar
  • 20 Metman E H, Lagasse J P, d'Alteroche L, Picon L, Scotto B, Barbieux J P. Risk factors for immediate complications after progressive pneumatic dilation for achalasia.  Am J Gastroenterol. 1999;  94 1180-1185
    PubMedGoogle Scholar
  • 21 Barkin J S, Guelrud M, Reiner D K et al.. Forceful balloon dilatation: an outpatient procedure for achalasia.  Gastrointest Endosc. 1990;  36 123-126
    PubMedGoogle Scholar
  • 22 Csendes A, Braghetto I, Henriquez A et al.. Late results of a prospective randomised study comparing forceful dilatation and esophagomyotomy in patients with achalasia.  Gut. 1989;  30 299-304
    CrossrefPubMedGoogle Scholar
  • 23 Fried R L, Rosenberg S, Goyal R. Perforation rate in achalasia with polyethylene balloon dilators.  Gastrointest Endosc. 1991;  37 405
    PubMedGoogle Scholar
  • 24 Stark G, Castell D O, Richter J E et al.. Prospective randomized comparison of Brown-McHardy and Microvasive balloon dilators in treatment of achalasia.  Am J Gastroenterol. 1990;  85 1322-1325
    PubMedGoogle Scholar
  • 25 Borotto E, Gaudric M, Danel B et al.. Risk factors for oesophageal perforation during pneumatic dilatation for achalasia.  Gut. 1996;  39 9-12
    PubMedGoogle Scholar
  • 26 , [No authors listed.] Esophageal dilation. Guidelines for clinical application.  Gastrointest Endosc. 1991;  37 122-124
    PubMedGoogle Scholar
  • 27 Lobello R, Edwards D AW, Gummer J WP et al.. The antireflux mechanism after cardiomyotomy.  Thorax. 1978;  33 569-573
    PubMedGoogle Scholar
  • 28 Ponce M, Ortiz V, Juan M et al.. Gastroesophageal reflux, quality of life, and satisfaction in patients with achalasia treated with open cardiomyotomy and partial fundoplication.  Am J Surg. 2003;  185 560-564
    CrossrefPubMedGoogle Scholar
  • 29 Black J, Vorbach A N, Collis J L. Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair.  Br J Surg. 1976;  63 949-953
    PubMedGoogle Scholar
  • 30 Nair L A, Reynolds J C, Parkman H P et al.. Complications during pneumatic dilation for achalasia or diffuse esophageal spasm. Analysis of risk factors, early clinical characteristics, and outcome.  Dig Dis Sci. 1993;  38 1893-1904
    CrossrefPubMedGoogle Scholar
  • 31 Heimlich H J, O'Connor T W, Flores D C. Cases for pneumatic dilatation in achalasia.  Ann Otol Rhino Laryngol. 1978;  87 519-522
    PubMedGoogle Scholar
  • 32 Eckardt V F, Kanzler G, Westermeler T. Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow-up study.  Gastrointest Endosc. 1997;  45 349-353
    CrossrefPubMedGoogle Scholar
  • 33 Wehrmann T, Jacobi V, Jung M et al.. Pneumatic dilation in achalasia with a low-compliance balloon: results of a 5-year prospective evaluation.  Gastrointest Endosc. 1995;  42 31-36
    CrossrefPubMedGoogle Scholar
  • 34 Nanson E M. Treatment of achalasia of the cardia.  Gastroenterology. 1966;  51 236-241
    PubMedGoogle Scholar
  • 35 Barnett J L, Eisenmann R, Nostrant T T et al.. Witzel pneumatic dilation for achalasia: safety and long-term efficacy.  Gastrointest Endosc. 1990;  36 482-485
    PubMedGoogle Scholar
  • 36 Vantrappen G, Hellemans J, Deloof W et al.. Treatment of achalasia with pneumatic dilatation.  Gut. 1971;  12 268-275
    CrossrefPubMedGoogle Scholar
  • 37 Perretta S, Fisichella P M, Galvani C et al.. Achalasia and chest pain: effect of laparascopic Heller myotomy.  J Gastrointest Surg. 2003;  7 692-700
    CrossrefPubMedGoogle Scholar
  • 38 Eckardt V R, Stauf B, Bernhard G. Chest pain in achalasia: patient characteristics and clinical course.  Gastroenterology. 1999;  116 1300-1304
    CrossrefPubMedGoogle Scholar
  • 39 Ali M E. Achalasia of the cardia in children.  Saudi Med J. 2003;  24 S40
    PubMedGoogle Scholar
  • 40 Fasulakis S, Andronikou S. Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication.  Pediatr Radiol. 2003;  33 682-687 , E-pub 2003 Aug 6
    CrossrefPubMedGoogle Scholar

Dr. Tarun Sabharwal

Department of Radiology, St Thomas' Hospital

Lambeth Palace Road, London

SE17EH, United Kingdom

Email: Tarun.Sabharwal@gstt.sthames.nhs.uk