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Pneumatic Dilation for the Treatment of Achalasia

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The AFS Textbook of Foregut Disease

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Abstract

Achalasia is the quintessential form of esophageal dysmotility characterized by abnormal lower esophageal sphincter (LES) relaxation and aperistalsis. Dilation of the LES has been at the forefront of the treatment of achalasia since 1674 when Sir Thomas Willis described dilation of the LES performed with a whalebone.

Modern use of pneumatic dilation for achalasia works by disrupting the LES smooth muscle fibers during a forceful stretch using a non-compliant air-filled balloon. Pneumatic dilation is easily performed and has proven durable clinical efficacy, resulting in excellent symptom relief, improved esophageal emptying on timed barium esophagram, and improvement of LES distensibility measured by functional luminal impedance planimetry (FLIP). After decades of use, pneumatic dilation remains a safe, effective, and cost-efficient procedure to treat achalasia and should remain at the forefront of treating disorders of esophagogastric outflow obstruction, especially achalasia. Pneumatic dilation should be part of any tertiary referral center’s achalasia treatment armamentarium.

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Author information

Authors and Affiliations

  1. Section on Gastroenterology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA

    Steven Clayton

  2. Division of Digestive Diseases and Nutrition, The Joy McCann Culverhouse Center for Esophageal Diseases, University of South Florida, Morsani College of Medicine, Tampa, FL, USA

    Joel E. Richter

Authors
  1. Steven Clayton
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  2. Joel E. Richter
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Corresponding author

Correspondence to Steven Clayton .

Editor information

Editors and Affiliations

  1. University of California, Irvine, Orange, CA, USA

    Ninh T. Nguyen

  2. Department of Gastroenterology & Hepatology, Stanford Digestive Health Clinic, Redwood City, CA, USA

    John O. Clarke

  3. Keck School of Medicine at USC, Los Angeles, CA, USA

    John C. Lipham

  4. Digestive Health Institute, University of California, Irvine, Orange, CA, USA

    Kenneth J. Chang

  5. Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York City, NY, USA

    Felice Schnoll-Sussman

  6. Institute of Esophageal & Reflux Surgery, Englewood, CO, USA

    Reginald C.W. Bell

  7. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Peter J. Kahrilas

Ethics declarations

Dr. Steven B. Clayton MD, FAAFP, FACP.

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The contributing authors have approved the final draft as submitted.

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The contributing authors have no funding sources to declare.

Conflicts of Interest

The contributing authors have no potential personal or financial conflict of interests.

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Clayton, S., Richter, J.E. (2023). Pneumatic Dilation for the Treatment of Achalasia. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_34

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  • DOI: https://doi.org/10.1007/978-3-031-19671-3_34

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-19670-6

  • Online ISBN: 978-3-031-19671-3

  • eBook Packages: MedicineMedicine (R0)

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