Balloon Dilation of Achalasia Cardia
Pneumatic balloon dilation is a primary, non-surgical treatment for achalasia cardia that uses a high-pressure, 30–35 mm balloon to tear the muscle fibers of the lower esophageal sphincter (LES), improving swallowing.
2–3 Days Before: Switch to a Soft Diet.
24–48 Hours Before (The Day or Two Prior): Switch to a Clear Liquid Diet.
The Night Before: Strict NPO (Nil Per Os): Do not eat or drink anything after midnight.
In cases of severe esophageal dilation (mega-esophagus), the doctor may require a liquid diet for up to 72 hours.
The procedure is done endoscopically under fluoroscopy, generally achieving 80–85% success, though it may require multiple sessions.
Procedural Presentation and Technique
- Procedure: A wire is inserted into the stomach, over which a Rigiflex balloon catheter is passed across the LES.
- Balloon Selection: Typically starts with a 30 mm balloon, followed by 35 mm (and 40 mm) if symptoms persist, with 3-4 week intervals.
- Inflation: The balloon is inflated to about 5-10 PSI for one minute to stretch the sphincter.
- Guidance: Done under endoscopic guidance (to detect immediate mucosal injury) and fluoroscopic control (to ensure proper position).
- Patient Position: Patients are usually under conscious sedation or general anesthesia.
Clinical Indications and Outcomes
- Target Patients: Ideal for patients with symptoms of dysphagia, regurgitation, and chest pain.
- Success Rates: Offers 70–85% long-term success, reducing LES pressure.
- Complications: The most serious, though rare, complication is esophageal perforation, with an overall rate of about 2–3%.
- Post-Procedure: A contrast swallow study may be performed 1–2 hours later to rule out perforation.
Advantages and Disadvantages
- Pros: Highly effective, minimally invasive alternative to surgery, and allows for outpatient treatment.
- Cons: High risk of recurrence may require repeated sessions.
It remains a gold standard for non-surgical management, often preferred in patients who are older or poor surgical candidates