SERIAL ENDOSCOPIC BALLOON DILATATION FOR ESOPHAGEAL ACHALASIA:A CASE REPORT
DOI:
https://doi.org/10.5281/zenodo.22251672Keywords:
Serial Endoscopic Balloon Dilatation, Management, Esophageal AchalasiaAbstract
Background: Achalasia is an esophageal motility disorder characterized by abnormal peristalsis and insufficient relaxation of the lower esophageal sphincter. Case Presentation: A 51-year-old male presented to the emergency room with dysphagia, nausea, vomiting, and a 30-kg weight loss over 1.5 years. Upper gastrointestinal endoscopy revealed Type II achalasia, while endoscopic biopsy identified a Type III hiatal hernia, with pathological examination demonstrating squamous hyperplasia. An esophagram showed achalasia involving the distal esophagus. A CT scan revealed esophageal dilatation at the level of the seventh thoracic vertebra (T7), measuring 4.6 × 2.5 cm. Intervention: The patient received nutritional support with a liquid diet and underwent upper gastrointestinal endoscopy followed by serial endoscopic balloon dilatation performed in three sessions. Balloon dilatation was carried out using a graded approach with progressive balloon diameters to reduce lower esophageal sphincter pressure while minimizing the risk of esophageal perforation. The patient was monitored clinically after each procedure, and no immediate procedure-related complications were observed. Out come: Following the final balloon dilatation session, the patient’s symptoms improved markedly. Dysphagia, nausea, and vomiting were significantly reduced, allowing progression from a liquid diet to a regular diet. The patient experienced weight gain and was able to resume normal daily activities. Conclusion: Following the third balloon dilatation session, the patient's symptoms improved markedly. Dysphagia, nausea, and vomiting, allowing progression from a liquid diet to a regular diet. The patient experienced weight gain and successfully resumed normal daily activities.
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References
Khashab MA, Vela MF, Thosani N, Agrawal D, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2020;91(2):213-227. doi:10.1016/j.gie.2019.04.231.
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393-1411.
Oude Nijhuis RAB, Zaninotto G, Roman S, Fockens P, Boeckxstaens GE, et al. European Guideline on Achalasia—United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United European Gastroenterol J. 2020;8(1):13-33.
Esposito D, Maione F, D'Alessandro A, Sarnelli G, De Palma GD. Endoscopic treatment for esophageal achalasia. World J Gastrointest Endosc. 2016;8(2):30–39. doi:10.4253/wjge.v8.i2.30.
Pesce M, Pagliaro M, Sarnelli G, Sweis R. Akalasia Modern: Diagnosis, Klasifikasi, dan Pengobatan. J Neurogastroenterol Motil. 2023;29(4):419–427. Available from: https://doi.org/10.5056/jnm23125
Fazlollahi N, Anushiravani A, Rahmati M, et al. Safety and Efficacy of Graded Gradual Pneumatic Balloon Dilation in Idiopathic Achalasia Patients: A 24-Year Single-Center Experience. Arch Iran Med. 2021;24(12):862-868. doi:10.34172/aim.2021.129.
Van Hoeij FB, Prins LI, Ponds FA, et al. Efficacy and safety of pneumatic dilation in achalasia: A systematic review and meta-analysis. Neurogastroenterol Motil. 2019;31(12):e13548. doi:10.1111/nmo.13548.
Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393-1411.
Oude Nijhuis RAB, Zaninotto G, Roman S, et al. European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United Eur Gastroenterol J. 2020;8(1):13-33. doi:10.1177/2050640620903213.
Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(2):160-174. doi:10.1111/nmo.12477.
Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135(5):1526-1533. doi:10.1053/j.gastro.2008.07.022.
Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807-1816. doi:10.1056/NEJMoa1010502.
Kumbhari V, Tieu AH, Onimaru M, et al. Peroral endoscopic myotomy versus pneumatic dilation in treatment-naive patients with achalasia: 5-year follow-up of a randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(12):1103-1111. doi:10.1016/S2468-1253(22)00300-4.
Kadakia SC, Wong RKH. Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):325-345. doi:10.1016/S1052-5157(18)30074-6.
Csendes A, Braghetto I, Burdiles P, et al. Late results of a prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia. Surgery. 2006;140(6):922-930.


