Achalasia Dilation

Achalasia dilation, also referred to as pneumatic balloon dilation, is a nonsurgical treatment for a rare but serious condition called achalasia that affects the esophagus.

Achalasia, also known as esophageal achalasia, is a condition in which the esophagus (the tube that carries food from the mouth to the stomach) is unable to move the food into the stomach. The lower esophageal sphincter (LES) is a ring of muscle fibers that surrounds the lower end of the esophagus where it joins the stomach. The LES acts like a valve between the esophagus and stomach, preventing the backflow of food. In people with achalasia, the LES fails to relax during swallowing, resulting in the food moving back up into the esophagus.

Dilation, sometimes called dilatation, refers to an act of enlarging, stretching, or widening a part or organ of the body. Achalasia dilation is an endoscopic procedure in which a special balloon is positioned at the LES and inflated in order to widen the opening for food to enter the stomach.

Indications

Achalasia dilation is indicated for patients with swallowing difficulty due to type 1, 2, and 3 esophageal achalasia.

• Type 1 refers to minimal contractility in the esophageal body
• Type 2 refers to intermittent periods of panesophageal pressurization
• Type 3 refers to spastic or premature distal esophageal contractions

Achalasia causes weakening of the upper esophageal muscles and prevents complete relaxation of the LES, making passage of food and liquids into the stomach difficult. These problems create difficulty in swallowing and can lead to weight loss, malnutrition, vomiting and dehydration.

Preparation

Procedure preparation for achalasia dilation may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any allergies to medications or anesthesia
• Informing your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease
• Refraining from certain medications, such as blood thinners or anti-inflammatories
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after the procedure

Procedure

Achalasia dilation is an outpatient endoscopic procedure usually performed under fluoroscopic guidance (live X-ray). An endoscope is a long, thin, flexible tube with a camera and light source at the end. Images from the camera are transmitted to a large monitor for your physician to view the inside of your esophagus. In general, the procedure involves the following steps:

• General or local anesthesia is administered to numb your throat. You may also be given sedation medicine to keep you relaxed.
• Your physician then inserts an endoscope through your mouth and into the esophagus. Fluoroscopy may be used to create continuous X-ray images on a monitor throughout the procedure.
• The tight lower esophageal sphincter near the top of the gastric folds is identified, and a catheter with a small, deflated balloon is passed over a guidewire into the area of abnormality.
• The balloon, which is about 1.2 to 1.6 inches (30 to 40 mm) in diameter is centered over the LES and inflated with air until wide enough.
• The balloon helps stretch out the muscles of the LES, expanding the opening so that food can pass through more easily.
• Once adequate stretching is achieved, the balloon is deflated and removed along with the guidewire and scope.

The procedure may need to be repeated to achieve satisfactory results.

Post Procedure Care

Post-procedure care and instructions may involve the following:

• You will be transferred to the recovery area where your nurse will monitor your condition as you recover from the effects of anesthesia/sedation.
• It is normal for you to feel soreness, pain or discomfort in the throat due to the tube used. Medications will be given to keep you comfortable.
• You should be able to take liquids once the anesthetic effect wears off and you no longer feel numbness in your throat.
• You should be able to eat a normal diet the same day or the next day.
• A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Achalasia dilation is a relatively safe procedure; however, some risks and complications may occur, such as:

• Bleeding
• Puncture or perforation
• Chest pain
• Acid reflux
• Hematoma
• Aspiration
• Adverse reactions to anesthesia

Summary

Achalasia dilation is a safe and effective treatment for achalasia. A cylinder-shaped balloon inflated with air is used to disrupt the muscle fibers of the lower esophageal sphincter, which are too tight in people with achalasia. It usually requires more than one treatment session to achieve satisfactory results, and this should be considered when deciding on the procedure.