Hydraulic dilation with a shape-measuring balloon in idiopathic achalasia: a feasibility study

Background and aim: Pneumatic dilation is a commonly used treatment in achalasia. Recent studies have shown that esophageal distensibility measurements can be used to assess the effect of dilation and possibly the risk of perforation. A new hydraulic dilation balloon allows visualization of the shape of the balloon in vivo and measurement of distensibility during dilation. We aimed to evaluate the technical feasibility of a 30-mm shape-measuring hydraulic dilation balloon for the treatment of achalasia.

Methods: Consecutive patients with newly diagnosed achalasia were dilated using a 30-mm shape-measuring hydraulic dilation balloon. Patients were contacted 1 week, 1 month, and 3 months after dilation. Technical success, clinical success, and major complications were evaluated.

Results: Technical success was achieved in all of the 10 patients included. Median esophagogastric junction distensibility (mm²/mmHg) increased from 1.1 (IQR 0.6 – 1.3) before dilation therapy to 7.0 (IQR 5.5 – 17.8) afterwards (P = 0.005). No major complications were seen. Three patients (30 %) reported recurrent dysphagia.

Conclusion: Hydraulic dilation with a shape-measuring balloon in achalasia patients is feasible. In vivo esophageal distensibility measurements may allow for an individualized, patient-specific dilation regimen.

The Netherlands National Trial Register: NTR4371

• References

• 1 Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 2001; 11: 235-248, v
• 2 Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology 2013; 145: 954-965
• 3 Boeckxstaens GE, Annese V, des Varannes SB et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. NEJM 2011; 364: 1807-1816
• 4 Rohof WO, Hirsch DP, Kessing BF et al. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 2012; 143: 328-335
• 5 Pandolfino JE. Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP™) in achalasia patients. Neurogastroenterol Motil 2013; 25: 496
• 6 Kwiatek MA. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 2010; 72: 272
• 7 Perretta S, McAnena O, Botha A et al. Acta from the EndoFLIP^® Symposium. Surg Innov 2013; 20: 545-552
• 8 O’Dea J, Siersema PD. Esophageal dilation with integrated balloon imaging: initial evaluation in a porcine model. Therap Adv Gastroenterol 2013; 6: 109-114
• 9 Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 2001; 11: 281-92, vi
• 10 Urbach DR, Tomlinson GA, Harnish JL et al. A measure of disease-specific health-related quality of life for achalasia. Am J Gastroenterol 2005; 100: 1668-1676
• 11 Frankhuisen R, Heijkoop R, van Herwaarden MA et al. Validation of a disease-specific quality-of-life questionnaire in a large sample of Dutch achalasia patients. Dis Esophagus 2008; 21: 544-550
• 12 Ogilvie AL. Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy. Gut 1982; 23: 1060
• 13 Rohof WO, Salvador R, Annese V et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 2013; 144: 718-725
• 14 Bredenoord A, Jafari J, Kadri S et al. Case report: achalasia-like dysmotility secondary to oesophageal involvement of sarcoidosis. Gut 2011; 60: 153-155
• 15 Farhoomand K, Connor JT, Richter JE et al. Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2004; 2: 389-394
• 16 Verlaan T. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc 2013; 78: 39
• 17 Rieder E. Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc 2013; 27: 400
• 18 EsoFLIP^® ES-330 Dilation Catheter (Model: ES-330): Instructions for Use. Available from: http://crospon.com/ES_330.pdf Accessed: 11 May 2015