Pneumatic Dilation Is Effective and Safe for Obstructing Esophageal Motility Disorders Based on Symptom Relief and Timed Barium Swallow

Abstract

Introduction: Pneumatic dilation (PD) is considered the major non-surgical treatment option in pts with achalasia and other obstructing esophageal motility disorders. There are scarce data on efficacy of PD in pts other than achalasia. Our aim was to compare post-PD improvement in symptoms and esophageal emptying assessed by timed barium swallow (TBS) in pts with obstructing esophageal motility disorders. Methods: A retrospective review of medical records of consecutive patients (pts) who underwent PD between 10/2011 and 11/2016 at our Institution. Data obtained from clinical records, manometric, endoscopic and TBS reports. TBS parameters pre- and post- PD recorded (barium height 1 min/5 min, 13 mm barium tablet retention after 10 min). One radiologist interpreted all TBS. Improvement in TBS defined by barium height decreased <2 cm at 5 min (Blonski et al. DDW 2017). Symptom improvement based on post-PD clinic visit recorded in the chart. Results: 162 pts (50% females), mean age 65.7 yrs, underwent 180 PD for dysphagia. Rigiflex balloon 30 mm (80%) or 35 mm (20%) with mean maximum PSI of 11.33 (range 5-16) was used. Balloon distended only once for 1min at esophagogastric junction. The indications for PD are shown in Figure 1 and Table 1. Repeated PD required in 18 pts: achalasia type 1 (n=2), achalasia type 2 (n=8), achalasia type 3 (n=1), achalasia S/P HM/POEM (n=1), EGJOO (n=5) and Nissen fundoplication (n=1). Table 2 shows symptomatic and TBS outcomes after PD. PD complications were experienced by 3 achalasia pts (esophageal perforation, n=1 and bleeding, n=2) for overall complication rate 1.7% for entire 180 PD.Figure: Indications for pneumatic dilation between 2011 and 2016.Table: Table. Detailed indications for pneumatic dilation between 2011 and 2016Table: Table. Symptom and TBS outcomes following pneumatic dilation in patients with obstructing esophageal motility disordersConclusion: 1. PD is very effective (symptom improvement 54%-87%) and safe treatment for obstructive esophageal motility disorders except Nissen fundoplication. 2. Type 3 achalasia and achalasia with prior surgical intervention do not do as well as other achalasia subtypes and EGJOO. 3. Barium column height <2 cm at 5 min is best physiological measurement for successful outcome after PD in pts with achalasia types 1 and 2. 4. Barium tablet passage is best physiological measurement for successful outcome in EGJOO and achalasia S/P HM/POEM, as well as type 2 achalasia.