scholarly journals Successful pneumatic dilatation of achalasia cardia in a preschool child

2009 ◽  
Vol 32 (4) ◽  
pp. 111
Author(s):  
K A W Karunasekera ◽  
R Fernando ◽  
A C Jayasinghe ◽  
S Rajendran
Keyword(s):  
Preschool Child ◽  
Pneumatic Dilatation ◽  
Achalasia Cardia

Outcome of Pneumatic Balloon Dilatation in Achalasia Cardia

2021 ◽  
Vol 10 (1) ◽  
pp. 8-13
Author(s):  
Shankar Baral ◽  
Bidhan NIdhi Paudel ◽  
Ajit Khanal ◽  
Jiwan Thapa ◽  
Bhuwneshwer Yadhav ◽  
...  
Keyword(s):  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Poor Response ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilatation ◽  
Response To Treatment ◽  
Sphincter Pressure ◽  
Achalasia Cardia ◽  
Type Iii ◽  
Esophageal Sphincter

Background: Achalasia Cardia is a rare esophageal motility disorder. Among various treatment options, Pneumatic Dilatation (PD) is the most widely used and cost effective modality till date. This is the first observational study aiming to evaluate the short term response and complications of PD for Achalasia Cardia in Nepal. Methods: This prospective observational study was conducted between 28th Jan 2020 to 27th Jan 2021. It included 39 patients with Achalasia Cardia diagnosed by clinical presentation, esophagoscopy, barium esophagogram and high resolution manometry. Two patients of Type III achalasia were excluded from study. Thirty seven patients underwent pneumatic dilatation with 30 mm Rigiflex balloon (Boston Scientific, USA) for a duration of 1 minute. Response was assessed by Eckardts score at 3 and 6 months. Result: Among 39 cases (mean age= 39.03±15.017 years, 59% men), commonest was Type II Achalasia (71.8%) followed by Type I (23.1%) and Type III (5.1%). Dysphagia was present in all patients (100%), followed by weight loss (84.6%), regurgitation (79.5%) and chest pain (35.9%). Mean basal Eckardts score and Lower Esophageal Sphincter pressure of the study population was 7.81±1.24 and 24.40±6.83 respectively. Response to pneumatic dilatation was 89.2%. Eckardts score changed significantly from7.81±1.24 to 1.03±1.82 at 6 months (p<0.001). None of the patients had major complications. Younger age (23±6.377 years) had poor response to treatment, while predilatation Lower Esophageal Sphincter pressure, gender and type of achalasia did not affect the treatment outcome. Conclusion: PD is safe and effective treatment modality for Achalasia. Younger patients have poor response to treatment with Pneumatic Dilatation.  

scholarly journals Outcome of pneumatic balloon dilatation of lower oesophageal sphincter of oesophagus of patients suffering from achalasia cardia

2016 ◽  
Vol 44 (2) ◽  
pp. 76-81
Author(s):  
ASM Nazmul Islam ◽  
Md Razibul Alamgir ◽  
Mohammed Atiqur Rahman ◽  
Anwarul Kabir ◽  
Faruque Ahmed ◽  
...  
Keyword(s):  
Balloon Dilatation ◽  
Treatment Options ◽  
Lower Oesophageal Sphincter ◽  
Pneumatic Dilatation ◽  
Barium Swallow ◽  
Pneumatic Dilation ◽  
Achalasia Cardia ◽  
Quasi Experimental ◽  
Esophageal Emptying ◽  
Pneumatic Balloon Dilatation

Achalasia is an oesophageal motility disorder of unknown cause, primarily characterized by absence of peristalsis of the esophageal body and impaired relaxation of lower oesophageal sphincter resulting invariably in dysphagia for solids/liquids or both and regurgitation of undigested foods. The diagnosis is usually made by classical symptoms, barium swallow X-ray of oesophagus or by endoscopy. Goal of treatment is to relieve symptoms, improve esophageal emptying and reduce the risk of associate complications. The two most successful treatment options are pneumatic dilation of lower oesophageal sphincter and surgical myotomy. This quasi-experimental study was carried out from January 2010 to December 2011 involving 31 patients of Achalasia Cardia admitted in the Department of Gastroenterology of BSMMU, Dhaka who underwent pneumatic balloon dilatation. Immediately after pneumatic dilatation all the patients got relief of dysphagia and were discharged from hospital next day. At follow-up 4 weeks after pneumatic dilatation, majority (96.2%) of the patients remained improved symptomatically. Significant weight gain was also found at 4 weeks after pneumatic dilatation. Pneumatic dilatation came out to be a simple, safe and effective method for treating patients with achalasia cardia.Bangladesh Med J. 2015 May; 44 (2): 76-81

scholarly journals Third-Space Endoscopy: Recent Updates

2021 ◽  
Vol 12 (03) ◽  
pp. 160-166
Author(s):  
Zaheer Nabi ◽  
D Nageshwar Reddy
Keyword(s):  
Third Space ◽  
Gastrointestinal Diseases ◽  
Pneumatic Dilatation ◽  
Promising Alternative ◽  
Achalasia Cardia ◽  
Esophageal Myotomy ◽  
Therapeutic Procedures ◽  
Long Term Follow Up ◽  
Endoscopic Myotomy

AbstractThird space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.

scholarly journals Achalasia Cardia: A Comprehensive Review

2020 ◽  
pp. 106-117
Author(s):  
Mohan Ramchandani ◽  
Partha Pal
Keyword(s):  
Lower Oesophageal Sphincter ◽  
Pneumatic Dilatation ◽  
Channel Blockers ◽  
Cell Degeneration ◽  
Achalasia Cardia ◽  
High Resolution Manometry ◽  
Limited Life ◽  
Retrosternal Pain ◽  
Unfit Patients ◽  
Undigested Food

Achalasia cardia is the best characterised oesophageal motility disorder. It is characterised by progressive ganglion cell degeneration in the oesophageal myenteric plexus, which results in impaired lower oesophageal sphincter (LES) relaxation upon swallowing and aperistalsis in the distal smooth muscle segment of the oesophagus. The usual presenting features are dysphagia to both liquids and solids from onset, regurgitation of undigested food, retrosternal pain, heartburn, and weight loss. Initial investigations include upper gastrointestinal (GI) endoscopy and timed barium oesophagogram, whereas high resolution manometry is diagnostic. Therapy in achalasia cardia is directed towards biochemical or mechanical reduction in LES pressures. If candidates are fit for surgery, pneumatic dilatation, peroral endoscopic myotomy, and laparoscopic Heller’s myotomy are the mainstays of therapy that act by mechanical disruption of LES. On the other hand, botulinum toxin and pharmacotherapy (nitrates and calcium channel blockers) act by biochemical reduction of LES and are reserved for surgically unfit patients with limited life expectancy because of their short-lived efficacy. Oesophagectomy is reserved for treating refractory longstanding cases, who have previously failed multiple therapies.

scholarly journals Clinical Outcome of Pneumatic Dilatation in Patients with Achalasia Cardia: A Single-Center Prospective Study

2017 ◽  
Vol 08 (04) ◽  
pp. 182-186
Author(s):  
Amit Hanmant Shejal ◽  
Thazhath Mavali Ramachandran ◽  
Sunil Kumar N
Keyword(s):  
Clinical Improvement ◽  
Balloon Dilation ◽  
Pneumatic Dilatation ◽  
Term Therapy ◽  
Symptom Duration ◽  
Achalasia Cardia ◽  
Eckardt Score ◽  
Long Term Therapy

ABSTRACT Background and Aim: Pneumatic balloon dilation is one of the most commonly used and effective methods for treating patients with achalasia cardia. This study was performed to assess immediate and long-term response of pneumatic dilatation (PD) in these patients. Materials and Methods: Forty-four achalasia cardia patients, who underwent PD in our center from January 2013 to December 2015, were prospectively studied. Data from these patients were analyzed for clinical improvement in symptoms after dilatation procedure over this period as per Eckardt score. Patients who required repeated procedure and factors influencing remission of symptoms were analyzed. Results: A total of 44 patients underwent PD, among which three lost to follow up. Of the 41 patients, 21 were male (51.22%) and 20 were females (48.78%). Mean age was 38.68 (13–64) years. Median symptom duration before first dilatation was 18 months (2–240). Major symptoms at presentation were dysphagia (n = 41, 100%), regurgitation (n = 38 92.68%), chest pain (n = 31, 75.6%), and weight loss (n = 20, 48.78%). Mean follow-up period was 22.22 months (9–38). Forty (97.56%) patients had immediate clinical improvement after 1 dilatation, of which 38 (92.68%) patients did not require any further treatment. Mean Eckardt score was 6.82 (4–11) at the time of first dilatation which improved to 0.66 during follow-up. Two patients required second dilatation (one 5 months and other 18 months after the first procedure). Conclusion: PD is a safe and effective long-term therapy for achalasia cardia and has a good long-term clinical remission.

Resolution of symptoms after Heller's cardiomyotomy with DOR fundoplication versus endoscopic balloon dilatation in patients with achalasia Cardia at tertiary care hospital

2021 ◽  
Author(s):  
Shahriyar Ghazanfar ◽  
Sajida Qureshi ◽  
Ali Rasheed ◽  
Fahad Memon ◽  
Mohammad Saeed Quraishy
Keyword(s):  
Balloon Dilatation ◽  
Treatment Success ◽  
Tertiary Care ◽  
Pneumatic Dilatation ◽  
Care Hospital ◽  
Dor Fundoplication ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Heller's Myotomy

Objective: The objective was to compare symptoms improvement following Heller's myotomy with DOR fundoplication (HM-DOR) and endoscopic pneumatic dilatation (PD) for the treatment of achalasia cardia at one year follow up. Methods: This prospective comparative study was conducted at department of upper GI and minimally invasive surgery, Civil hospital Karachi from February 2016- January 2019. All patients diagnosed as a case of achalasia cardia on esophageal manometry were included in this study. Subjects were grouped into two treatment groups: Endoscopic Pneumatic Dilatation(PD) and laparoscopic Heller's myotomy with DOR fundoplication (HM-DOR). Results: A total of 42 patients were taken into study, of which 21 patients were randomly assigned in each of the two groups (surgery and endoscopic). Mean age of patients undergoing laparoscopic Heller’s myotomy and endoscopic pneumatic balloon dilatation was 34±8.59 and 37±12.87 years respectively. Treatment success in PD group was 52% (11/21) as compared to HM-DOR group which was 76% (16/21). Post Eckardt scores reduction at 1 year follow up between PD and HM-DOR were statistically significant (p<0.001). Patient satisfaction measured by likert's scale was significantly more in the surgery group. Conclusion: The efficacy of HM appears to be greater than PD for improvement in dysphagia and overall patients satisfaction score over a 1 year follow up period. Keywords: Esophageal achalasia, Heller’s myotomy (HM), Endoscopic pneumatic dilatation (PD). Continuous...

scholarly journals A case report on achalasia cardia type - II

2019 ◽  
Vol 6 (9) ◽  
pp. 3401
Author(s):  
Sadiya Mustafavi ◽  
Atif Abdul Samee ◽  
Shafia Siddiqui ◽  
Tanveer Yousra
Keyword(s):  
Case Report ◽  
Neurodegenerative Disorder ◽  
Delayed Diagnosis ◽  
Autoimmune Disorder ◽  
Pneumatic Dilatation ◽  
Achalasia Cardia ◽  
Heller’S Myotomy ◽  
Heller's Myotomy ◽  
One Year ◽  
Dor’S Fundoplication

Achalasia cardia is the rare chronic neurodegenerative disorder of the esophagus which causes progressive delay in contractility of lower esophageal muscles during swallowing leading to backup of food contents and fluids in later stages within the region of esophagus. It is considered as the common leading cause of motor dysphagia. The underlying etiology include autoimmune disorder, nervous degeneration due to loss of inhibitory ganglion in myenteric plexus of esophagus, presence of inhibitory neurotransmitters such as nitric oxide and its receptors in lower esophagus. At initial presentation drugs are prescribed as the symptoms mimic other GI disorders which often lead to delayed diagnosis. The symptoms mainly include severe pain or discomfort of chest after eating, weight loss, regurgitation of bland undigested food or saliva, severe heartburn, dysphagia, aspiration. Initial treatment includes the pharmacotherapeutic management to alleviate the symptoms and improve the esophageal outflow. Surgical treatment involves pneumatic dilatation, Heller’s myotomy, preoral endoscopic myotomy, esophagectomy. Heller’s myotomy may be performed by open or laparoscopic procedure. It is done along with Dor’s fundoplication. Case report discussed below is of a 55 years old female patient presented with dysphagia for one year. The symptoms of which worsened for 2 months along with vomiting of undigested foul-smelling food.

T1899 Achalasia Cardia Subtyping Based on Pressure Topography on High Resolution Manometry Can Predict Therapeutic Outcome of Endoscopic Pneumatic Dilatation

2010 ◽  
Vol 138 (5) ◽  
pp. S-602
Author(s):  
Nitesh Pratap ◽  
Rakesh Kalapala ◽  
Mohan Ramchandani ◽  
Rupa Banerjee ◽  
Sandeep Lakhtakia ◽  
...  
Keyword(s):  
High Resolution ◽  
Pneumatic Dilatation ◽  
Therapeutic Outcome ◽  
Achalasia Cardia ◽  
High Resolution Manometry

PS01.115: ESOPHAGECTOMY FOR ACHALASIA CARDIA: A SINGLE TEAM EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 82-82
Author(s):  
Servarayan Chandramohan ◽  
Kanagavel Manickavasagam ◽  
Madeshwaran Chinnathambi ◽  
Abishai Jebaraj ◽  
Apsara Chandramohan ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
High Volume ◽  
Transhiatal Esophagectomy ◽  
Pneumatic Dilatation ◽  
Duration Of Symptoms ◽  
Achalasia Cardia ◽  
Esophagus Perforation ◽  
Per Oral ◽  
Sigmoid Esophagus

Abstract Background In the era of per oral endoscopic myotomy, advancement in manometry and laparoscopy the treatment for achalasia cardia is well defined. Oesophagectomy has only a limited role in rare patients with sigmoid esophagus, perforation during nonsurgical treatment and malignancy. This study is about the indications of esophagectomy for achalasia cardia from one of the high volume centers for upper gastrointestinal disorders in India Methods This study includes 10 patients (7 male, 3 female) between august 2010 to august 2016.They had symptoms like dyspnea, dysphagia, regurgitation, chest discomfort, weight loss and cough. The duration of symptoms range from 2–120 months. Seven patients underwent previous pneumatic dilatation, four underwent Laproscopic Hellers cardiomyotomy with fundoplication (dor 3, toupet 1) and one patient had both pneumatic dilatation and cardiomyotomy. Results The indications for esophagectomy were sigmoid esophagus, failed pneumatic dilatation and laproscopic hellers cardiomyotomy, perforation after pneumatic dilatation and malignancy. The procedures done were transhiatal esophagectomy with stomach pull-up in 8 patients, Transthoracic esophagectomy in one, Esophagogastrectomy with transabdominal intrathoracic esophagojejunal anastomosis in one patient. The follow-up range between 14–84 months. During follow-up one patient developed hepatocellular carcinoma right lobe and died. Conclusion In the era where nonresection treatment play a major role in the management of achalasia cardia, esophagectomy still has a role in select patients. The indications for esophagectomy in our series included failed endotherapy, failed Hellers cadiomyotomy, sigmoid esophagus and malignancy. Disclosure All authors have declared no conflicts of interest.

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