Background: Based on studies and some clinical practice pneumatic dilatation utilizing the widely available wire guided polyethylene pneumatic dilator system using a 30mm balloon inflated for 15 seconds upon loss of waist noted (during fluoroscopy) at 7 to 10psi obtains optimal disruption of the lower esophageal sphincter. We employed this technique till August 2001 without any complications (notably perforation) with good clinical outcome and durability.
Aims: To study the efficacy of pneumatic dilatation with the pneumatic balloon dilated only till loss of waist.
Materials and Methods: A total of 10 treatment naïve achalasia patients enrolled from August 2001 till July 2002 were dilated till loss of waist and the outcome and durability was compared with our historical controls.
Findings: A total of 10 patients with age 45±18 (range 22-67) years with 8 females: 2 males and 5 Malays: 5 Chinese with 3 patients with megaoesophagus underwent pneumatic dilatation using a 30 mm Rigiflex® pneumatic dilator till loss of waist was noted during fluoroscopy at 7psi and the balloon deflated immediately. All the patients reported symptomatic improvement in dysphagia, regurgitation and demonstrated a 3-12 month post procedural weight gain of 6±5 (range: 1-15) kg. One patient required a second dilatation only after 13 months. All the remaining patients remain well till today after the initial single dilatation. The durability of the dilatation was 27±7 months (range: 13-33) months. There were no complications noted. There were no complaints of excessive reflux. This data was compared with our historical control (patients before August 2001), i.e. the pneumatic dilator inflated for 15 seconds upon loss of waist, and there was no difference in clinical outcome, or the durability of dilatation or the duration of stay post procedure.
Conclusion: Forceful disruption of the lower esophageal sphincter utilizing the pneumatic dilator is effective but is associated with a 1-5% risk of perforation. We obtained identical results without loss of clinical improvement or durability utilizing our technique compared to the traditional method. Since August 2001 all our dilatations were performed in our unit utilizes this simplified method. We have yet to report a perforation after pneumatic dilatation.