graded p neumatic dilatation wi thout fluoroscopy in the t reatment of esophageal achalasia

between 1993-1996 seventy-three consecutive patients (33 m, 40 f, mean age 35.4) with newly diagnosed achalasia underwent one or more pneumatic dilatations with the rigiflex balloon using a protocol of graded dilatation with a fixed inflation pressure of 10 psi and constant duration of 30 seconds for all patients without using fluoroscopy. using vantrappen's classification for assessment of response, excellent or good results were considered as cure and fair or poor results as failure. duration of symptoms and the amount of weight loss before dilatation averaged 5.2 years and 10 kg, respectively. in 62 patients one, in 5 patients two, and in 4 patients three dilatations were performed. dilatation failed in one patient because of previous surgery and was followed by perforation in one patient (1.4%) and bleeding in another patient (1.4%). follow up period averaged 20 months (range 6-38 months) with a cure rate of 90% (57 excellent, 9 good) and failure rate of 6.8% (3 fair, 2 poor). we conclude that graded pneumatic dilatation without fluoroscopy is a safe and very effective treatment for achalasia with 90% of patients having a sustained response lasting at least for an average of 20 months.