ENDOSCOPE GUIDED PNEUMATIC DILATATION OF ACHALASIA CARDIA: EFFICACY, OUTCOMES AND COMPLICATIONS AT A SINGLE TERTIARY CARE CENTRE

Mohammed Noufal B; Venkateswaran A R; Kani Shaikh M; Malarvizhi M; Radhakrishnan N; Thinakar Mani B; Sibithooran K

Volume : VII, Issue : III, March - 2018

ENDOSCOPE GUIDED PNEUMATIC DILATATION OF ACHALASIA CARDIA: EFFICACY, OUTCOMES AND COMPLICATIONS AT A SINGLE TERTIARY CARE CENTRE

Mohammed Noufal B, Venkateswaran A R, Kani Shaikh M, Malarvizhi M, Radhakrishnan N, Thinakar Mani B, Sibithooran K

Abstract :

Introduction: Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by te� its muscle fibers by generating radial force which is done endoscopically without fluoroscopic control using a low–compliance balloon such as Rigiflex dilator . It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal te�.

Aim: To study the series of cases of achalasia cardia, managed by pneumatic dilatation and observe their efficacy, outcomes and complications presenting in our centre during the period of July 2015 to 2017

Methods: 27 cases of achalasia cardia which presented to our centre during July 2015 to 2017 and managed by endoscope guided pneumatic dilatation were retrospectively analysed and their outcomes were observed.

Results: 25 of 27 patients with achalasia presented with dysphagia for solids or liquids. 20 patients had regurgitation and vomiting. Weight loss of more than 5 Kg was observed in 10 patients. History of nocturnal cough was present in 7 patients. 35 dilatations were performed in 27 patients. All patients had relief of dysphagia and regurgitation within 24 hours. Barium swallow within a week of dilatation showed a decrease in the maximum diameter of the oesophagus from 42.4 + 11.4 mm to 30.5 + 10.5 mm and increase in the diameter of the narrowed lower segment from 2.45 + 1.5 mm to 11.4+ 2.2 mm. None of the patients showed a hold up of barium after dilatation. 20 patients complained of retrosternal pain during procedure but none persisted for 24 hours. No perforations were encountered during the study. There was no procedural mortality .

Conclusion: Endoscope–guided PD is an efficient and safe nonsurgical therapy with results comparable to other treatment modalities.