Short-term and long-term results of pneumatic dilation in the treatment of patients with esophageal achalasia: 16 years of experience

Background: Pneumatic dilation (PD) is still a common treatment of oesophageal achalasia. This retrospective analysis informs about 16 years of experience with pneumatic dilation in the treatment of patients with achalasia. Patients and methods: Consecutive patients with achalasia treated with endoscopic balloon dilation therapy were analysed retrospectively. The success of endoscopic pneumatic dilation was defined as no treatment other than pneumatic dilation and the overall clinical Eckardt score ≤ 3 (and at the same time each individual item <2). Results: From January 2004 to December 2019, 140 patients with achalasia consecutively underwent pneumatic dilation (67 males [47.9%], mean age 54.9 ±16.2 years). The median follow-up since the first dilation was 125 months (range 6–263 months). Satisfactory results were observed in 130 patients (92.9%). Out of the remaining ten patients, two (1.4%) had periprocedural oesophageal perforation and in 8 (5.7%) patients the treatment effect was insufficient. Out of all patients, 107/140 (76.4%) had only one PD, 22/140 (15.7%) had two PDs, three PDs were performed in 8/140 (5.7%) and four PDs in 3/140 (2.1%). Treatment failure was more common in patients who had more pneumatic dilations (1 PD 37.5%, 2 and more PDs 62.5%; P = 0.019). Conclusions: Endoscopic balloon dilation, starting with a 35 mm balloon, is an effective treatment for achalasia in the short and long term, with minimal morbidity. The possible incomplete effect of dilation therapy is more often manifested in an earlier period after the initial dilation therapy. Keywords achalasia, pneumatic dilation, long-term results, complications