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Achalasia pp 39–44Cite as

Pneumatic Dilation

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Abstract

Achalasia is caused by the selective loss of inhibitory neurons in the myenteric plexus resulting in failure of the lower esophageal sphincter (LES) to relax. Pneumatic dilation is a therapeutic maneuver used to palliate symptoms by stretching and controlled mechanical disruption of the circular smooth muscle fibers of the LES and resultant fracture of the muscularis propria. Significant predictors of favorable clinical outcomes after PD include LES pressure after dilation of less than 10 mmHg, older age, female gender, and type II achalasia pattern on high resolution manometry. Common complications are rare but include perforation, chest pain, bleeding, fever, aspiration pneumonia, and formation of diverticula. Overall, PD is considered to be the most cost-effective first-line therapy for achalasia over a 5–10 year post-procedure period and should be performed at high volume clinical centers if possible.

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Authors and Affiliations

  1. Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago, Chicago, IL, USA

    Vijaya Rao MD

  2. Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, IL, USA

    Robert Kavitt MD, MPH

Authors
  1. Vijaya Rao MD
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  2. Robert Kavitt MD, MPH
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Corresponding author

Correspondence to Vijaya Rao MD .

Editor information

Editors and Affiliations

  1. Brigham and Women’s Hospital Harvard Medical School, West Roxbury, Massachusetts, USA

    P. Marco Fisichella

  2. Surgery, São Paulo Medical School, São Paulo, São Paulo, Brazil

    Fernando A. M. Herbella

  3. Surgery, University of Chicago, Chicago, Illinois, USA

    Marco G. Patti

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© 2016 Springer International Publishing Switzerland

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Rao, V., Kavitt, R. (2016). Pneumatic Dilation. In: Fisichella, P., Herbella, F., Patti, M. (eds) Achalasia. Springer, Cham. https://doi.org/10.1007/978-3-319-13569-4_6

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  • DOI: https://doi.org/10.1007/978-3-319-13569-4_6

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13568-7

  • Online ISBN: 978-3-319-13569-4

  • eBook Packages: MedicineMedicine (R0)

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