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. 2018 Sep;32(9):4017-4021.
doi: 10.1007/s00464-018-6271-4. Epub 2018 Jun 15.

S093: Pneumatic Balloon Dilation for Palliation of Recurrent Symptoms of Achalasia After Esophagomyotomy


S093: Pneumatic Balloon Dilation for Palliation of Recurrent Symptoms of Achalasia After Esophagomyotomy

Riley D Stewart et al. Surg Endosc. .


Background: Achalasia is a chronic disease affecting the myenteric plexus of the esophagus and lower esophageal sphincter. Treatment is aimed at palliating symptoms to improve quality of life. Treatment options for symptom relapse after esophagomyotomy include botox injection, repeat myotomy, per-oral endoscopic myotomy, or pneumatic balloon dilation (PBD). Data demonstrating the safety and efficacy of PBD for recurrence are scarce. With a lack of published data, guidelines have suggested avoiding PBD for recurrent achalasia because of concern for a high risk of perforation.

Methods: A retrospective review of patients who underwent PBD for recurrent symptoms of achalasia after esophagomyotomy between 2007 and 2017 was conducted. PBD was performed at 30 mm and held for 60 s under fluoroscopic guidance. Patients with residual symptoms had subsequent dilations at increasing 5 mm increments to a maximum of 40 mm. Patient demographics, Eckardt scores, presence of hiatal hernia, time from myotomy to recurrence, and diagnostic modalities were reported. The primary outcome was need for further endoscopic or surgical intervention. Complications are reported as secondary outcomes.

Results: One-hundred eight esophagomyotomies were done during the study period. Fourteen patients underwent PBD for recurrent symptoms. The median time to symptom recurrence after esophagomyotomy was 28 months. The median Eckardt score was 6. Ten of 14 patients had an intervention between the initial surgery and PBD (9 standard dilations and 1 botox injection). A total of 23 PBD were done. Seven patients required dilation at 35 mm and two patients required dilation at 40 mm. Eleven patients required no further intervention at a median follow-up of 27.7 months. There were three treatment failures: one required repeat esophagomyotomy and two had no further treatments. There were no periprocedural complications.

Conclusion: Serial PBD is safe and effective in treatment of recurrent symptoms of achalasia after esophagomyotomy.

Keywords: Achalasia; Esophagomyotomy; Pneumatic balloon dilation; Recurrence.

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  • 2019 Seoul Consensus on Esophageal Achalasia Guidelines.
    Jung HK, Hong SJ, Lee OY, Pandolfino J, Park H, Miwa H, Ghoshal UC, Mahadeva S, Oshima T, Chen M, Chua ASB, Cho YK, Lee TH, Min YW, Park CH, Kwon JG, Park MI, Jung K, Park JK, Jung KW, Lim HC, Jung DH, Kim DH, Lim CH, Moon HS, Park JH, Choi SC, Suzuki H, Patcharatrakul T, Wu JCY, Lee KJ, Tanaka S, Siah KTH, Park KS, Kim SE; Korean Society of Neurogastroenterology and Motility. Jung HK, et al. J Neurogastroenterol Motil. 2020 Apr 30;26(2):180-203. doi: 10.5056/jnm20014. J Neurogastroenterol Motil. 2020. PMID: 32235027 Free PMC article. Review.


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