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. 2019 Jul;31(7):e13548.
doi: 10.1111/nmo.13548. Epub 2019 Jan 30.

Efficacy and Safety of Pneumatic Dilation in Achalasia: A Systematic Review and Meta-Analysis

Free PMC article

Efficacy and Safety of Pneumatic Dilation in Achalasia: A Systematic Review and Meta-Analysis

Froukje B van Hoeij et al. Neurogastroenterol Motil. .
Free PMC article


Background and aims: One of the most used treatments for achalasia is pneumatic dilation of the lower esophageal sphincter to improve esophageal emptying. Multiple treatment protocols have been described with a varying balloon size, number of dilations, inflation pressure, and duration. We aimed to identify the most efficient and safe treatment protocol.

Methods: We performed a systematic review and meta-analysis of studies on pneumatic dilation in patients with primary achalasia. Clinical remission was defined as an Eckardt score ≤3 or adequate symptom reduction measured with a similar validated questionnaire. We compared the clinical remission rates and occurrence of complications between different treatment protocols.

Results: We included 10 studies with 643 patients. After 6 months, dilation with a 30-mm or 35-mm balloon gave comparable mean success rates (81% and 79%, respectively), whereas a series of dilations up to 40 mm had a higher success rate of 90%. Elective additional dilation in patients with insufficient symptom resolution was somewhat more effective than performing a predefined series of dilations: 86% versus 75% after 12 months. Perforations occurred most often during initial dilations, and significantly more often using a 35-mm balloon than a 30-mm balloon (3.2 vs 1.0%); P = 0.027. A subsequent 35-mm dilation was safer than an initial dilation with 35 mm (0.97% vs 9.3% perforations), P = 0.0017.

Conclusions: The most efficient and safe method of dilating achalasia patients is a graded approach starting with a 30-mm dilation, followed by an elective 35-mm dilation and 40 mm when there is insufficient symptom relief.

Keywords: achalasia; balloon dilation; efficacy; safety.

Conflict of interest statement

AB received research funding from Endostim, Medical Measurement Systems, Danone and given and received speaker and/or consulting fees from MMS, Astellas, AstraZeneca and Almirall. LP, FH, and AS have no conflict of interest to declare.


Figure 1
Figure 1
Flowchart of literature search, screening, and selection
Figure 2
Figure 2
Remission rates per article after 6 mo (left) and 12 mo (right) of follow‐up, comparing dilation up to 30, 35, and 40 mm
Figure 3
Figure 3
Remission rates per article after 6 mo (left) and 12 mo (right) of follow‐up, comparing studies that used a predefined dilation protocol (“Scheme”) with studies in which additional dilations were performed when symptom recurrence occurred (“Redilation”)

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    Oude Nijhuis RAB, Zaninotto G, Roman S, Boeckxstaens GE, Fockens P, Langendam MW, Plumb AA, Smout A, Targarona EM, Trukhmanov AS, Weusten B, Bredenoord AJ. Oude Nijhuis RAB, et al. United European Gastroenterol J. 2020 Feb;8(1):13-33. doi: 10.1177/2050640620903213. United European Gastroenterol J. 2020. PMID: 32213062 Free PMC article.


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