Revista Colombiana de Gastroenterologia
versão impressa ISSN 0120-9957
GARZON, Martín et al. Acalasia: Dilatación neumática: Experiencia en un hospital de referencia. Rev Col Gastroenterol [online]. 2005, vol.20, n.3, pp. 6-9. ISSN 0120-9957.
Achalasia has an incidence of 1:100.000. The therapy for achalasia, focus on reducing the pressure gradient across the LES, which can be achieved by forceful pneumatic dilation of the gastroesophageal junction, surgical myotomy or by pharmacological agents, injected endoscopically or taken orally. Pneumatic balloon dilation is regarded as the first-line treatment, with an initial success rate of 85% to 90%. OBJECTIVE: The objective of this study is to show our experience with pneumatic balloon dilation in the patients with diagnosis of achalasia from the hospital La Samaritana during a period from February 2002 to February 2005. METHODS: Patients diagnosed with achalasia from the department of gastroenterology and endoscopy of the Hospital La Samaritana during period of February 2002 to February 2005 were included. Procedures were made in fluoroscopy room. The patients received intravenous sedation and analgesy. We used a Regiflex balloon, 3.5 cm diameter. Balloons were inflated with saline water and water-soluble contrast during one minute. RESULTS: We diagnosed 19 patients with achalasia during period from February 2002 to February 2005, 14 were females (74%) and 5 males (26%); we made pneumatic dilation in 11 patients (60%), 9 were females (82%) with mean age 38.9 years (ranged from 16 to 73 years). Three patients (27%) underwent once pneumatic dilation and the rest (8 patients) underwent twice (73%). We dont report any perforation. So far we have followed the patients ambulatory during period from 6 months to 2 years. We find recurrence one year after of the pneumatic dilation in a female patient 22 years old (9%). CONCLUSION: The pneumatic dilation as cost-effective therapy, with a good initial success, but in the longer the follow-up lower the success rate and low morbility (4). We suggest to make only two pneumatic dilations. Today, there isnt consensus on the optimal endoscopic dilation technique and we believe that the sedation must be included in this procedure. In the future, we need more comparative trials of pneumatic dilations against minimally invasive surgery (laparoscopic myotomy) to establish the best treatment way in patients with achalasia.
Palavras-chave : Achalasia; Pneumatic dilation; Lower esophageal sphincter (LES).