Endoscopic Assessment of Effacement of Balloon Waist during Pneumatic Dilatation of Primary Achalasia Cardia under Topical Anesthesia

Objective: Balloon dilatation of Primary Achalasia Cardia (PAC) is usually performed under antegrade endoscopic guidance, with conscious sedation. The main goals of this prospective study were to assess the safety and efficacy of pneumatic dilatation without conscious sedation and to determine the endoscopic signs of effacement of the balloon”waist”. Methodology: Pneumatic dilatation was successfully performed as outdoor procedure without conscious sedation in patients (n= 25; mean age 42.56 years) with endoscopic and radiologic diagnosis of PAC. Results: Immediate relief of symptoms was observed in 23 (92%) cases. Effacement of the balloon “waist” under endoscopic vision was appreciated in all cases in the present study. Common complications of pneumatic dilatation were chest pain in all (100%) subjects and mild local bleeding in 17 (68%) patients. There was no cancellation of procedure. Re-dilatation was required in 2 (8%) cases. The duration of follow-up was from 6 weeks to 23 months. Conclusions: Pneumatic dilatation of PAC can be safely performed as same day procedure, without conscious sedation. Obliteration of the balloon “waist” can be readily determined by antegrade “endoscopic assessment of stretch on the lower oesophageal sphincter (EASL)”.