Large-diameter balloon dilation for the treatment of achalasia of cardia: an analysis of mid-to-long term efficacy in 80 cases

Objective: To discuss the technical points of large-diameter (40 mm) balloon dilation in treating achalasia of cardia, and to assess its mid-to-long term efficacy. Methods: A total of 80 patients of achalasia of cardia with a disease course of 3-23 years were enrolled in this study. According to Mellow-Pinkas standard of the dysphagia grading (from 0 to Ⅳ), the patients were classified into grade Ⅰ (n=6), grade Ⅱ (n=60) and grade Ⅲ (n=14). The diagnosis was confirmed by barium meal examination in all patients. Under spraying anesthesia of pharyngeal portion with 2% lidocaine, the intensified guide wire was inserted into the stomach through mouth under fluoroscopy guidance. The Boston's balloon (40 mm in diameter) was pushed along the guidewire to the stricture site at the cardia and was gradually inflated with 15% contrast medium by using the 'graded intermittent inflation' technique. Namely, the balloon was inflated to a maximum diameter and was kept in this condition for five minute, and then the balloon was deflated for 3-5 minutes. The above procedure was repeated 2-3 times. For the severe stricture, pre-dilatation with 20-25 mm diameter balloon was carried out. As a routine, postoperative measures to prevent possible bleeding and infection were adopted. The patient was allowed to take cool liquid diet 2-3 hours after the procedure, to have semi-liquid diet within three days and then to take normal diet. The patients were followed up for 2-10 years. Results: The balloon insertion was technically successful in all of the 80 patients. The success rate of single and twice manipulations was 96.3% (77/80) and 3.7% (3/80), respectively. Postoperative rupture of the cardia region was seen in one patient, and surgical repair had to be carried out. The follow-up time ranged from 2 years to 10 years (mean 6.27 years). No recurrent stenosis occurred in all patients. The remission rate of dysphagia was 100%. The swallowing function returned to normal in 90% of patients (72/80). Mild esophageal reflux occurred in 12 patients. Conclusion: For the treatment of achalasia of cardia, dilatation with large-diameter balloon is technically-simple, minimally-invasive, effective and economical, and the mid-to-long term efficacy is fine and reliable. Therefore, this technique should be regarded as the treatment of first choice for adult patients. (authors)