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conferenceseries
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Volume 7, Issue 7 (Suppl)
J Gastrointest Dig Syst
ISSN: 2161-069X JGDS, an open access journal
Gastroenterologists 2017
December 14-15, 2017
December 14-15, 2017 Dubai, UAE
11
th
World
Gastroenterologists Summit
The efficacy of balloon dilation in achalasia is the result of stretching of the lower esophageal sphincter,
not muscular disruption
Fathali Borhan-Manesh, Mohammad J Kaviani and Ali R Taghavi
Shiraz University of Medical Sciences-Nemazee Hospital, Iran
Background:
Pneumatic dilation (PD) of the lower esophageal sphincter (LES) is a major palliative treatment in achalasia. It
is generally believed and frequently stated in the Gastroenterology Textbooks and Journals, that the beneficiary effect of PD in
achalasia, is the result of rupture of the circumferential muscular layer of the LES, as done inHeller surgical procedure. However,
the effectiveness of PD, contrary to that of Heller myotomy, is often short lived, and recurrence of dysphagia necessitates repeat
PD with a larger balloon diameter (35-40 mm).
Aims:
The lack of durability of effectiveness of PD in achalasia and the lack of any previous study in support of the presumptive
mechanism of action of PD to explain the effectiveness of this procedure, prompted the author to investigate the state and
the integrity of the LES, 24 hours after PD and clarify the most likely mechanism for symptomatic relief after PD in achalasic
patients.
Method:
To look for and detect the occurrence and the extent of any muscular disruption at the LES, 43 eligible and consenting
patients with definite diagnosis of achalasia, underwent endoscopy ultra-sound, using Olympus GF-UE160 echoendoscope
with an Aloka prosound probe at 7.5 MHZ, 24 hours after PD.
Results:
Out of 43 patients, 36 (83.7%) revealed an intact LES, 5 (11.6%) demonstrated small area of muscular disruption and
2 (4.6%) showed small hematoma. None of the investigated patients developed symptoms or signs of esophageal perforation.
Conclusion:
Our results convincingly demonstrate that clinical improvement from PD in achalasia is not related to rupture
of the muscular layer of the LES, but is the result of circumferential stretching of the LES. One may also conclude from this
study that any muscular disruption from PD in achalasia should be considered a complication of the procedure and not the
intended result.
fathali_borhan@yahoo.comJ Gastrointest Dig Syst 2017, 7:7 (Suppl)
DOI: 10.4172/2161-069X-C1-062