Modified dilatation method of achalasia

Introduction: The missing ganglions of the cardia muscle can cause serious nutrition difficulties of the patients. To treat this disease there are surgical and non surgical methods available. The surgical methods either open or laparoscopic are clear and well established. The previously used non surgical methods put the emphasis on the X -Ray availability, requested an substantial staff involvement together with irradiation load and was an relatively time consuming procedure.

Method: Since the second half of 2005 we performed on 11 patients the modified dilatations procedures. Upon finished the upper endoscopy investigation we pushed through the guide wire through the working channel and placed it into the stomach. We take the scope out and pushed through the Savary balloon dilatator via the wire into the esophagus, while the gastroscope was replaced into the patient. With the help of the scope we were able to meticulously define the place of the balloon was pushed through carefully to the stomach. The exact place of the balloon can be established with the help of the black signs of the balloon. We began to inflate the well positioned balloon up to 120–140 Hgmm, maintained it as long as 1.5–2 minutes.

Upon finished this treatment we take the scopes and the balloon too, and precede a swallow X-Ray investigation with soluble contrast material. To give cold water to drink is essential.

Results: All patients showed a substantial improvement of their outflow through the cardia.

All patients but seven got one time dilatation while 3 got two times and only one patient need to have more than two dilatation process.

No surgical intervention should apply on these patients.

Summary: The method can be executed with less staff, without heavy X-ray involvement, and of course, without radiation load. It proved to be safe for the patient, furthermore cost and time saving.