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1 . 2022

Endoscopic balloon hydrodilation in the treatment of achalasia of the cardia

Abstract

Material and methods. From May 1986 to September 2021, 103 (25.6%) of 403 patients with achalasia cardia underwent endoscopic balloon hydrodilatation - in combination with pneumodilatation (80) or as an self-dependent method (23). The data on the hydrodilatation of the cardia were analyzed in detail for the period from April 2012 to September 2021 in 31 patients (20 men, 11 women) aged 18 to 88 years. Hydrodilatation of the cardia was mainly performed using a balloon with a diameter of 40 mm, which was put on the endoscope. High-resolution manometry was performed in 23 patients, 9 of them after a completed course of endoscopic balloon dilatation. 

Results. The combined assessment of the results of endoscopic treatment of achalasia cardia is based on clinical, radiological and endoscopic criteria. In 73.2% (295/403) patients, good results were achieved, in 22.3% (90/403) - satisfactory results, including due to the use of hydrodilatation in 1/4 of the total number of patients. In the analyzed group of 31 patients who underwent cardia hydrodilatation, 87.1% (27/31) completed the course of treatment with a good effect, including 3 patients after operations on the cardia and cicatricial strictures in the region of esophagogastric junction, in which hydrodilatation was the only possible treatment. According to high-resolution manometry, in 88.9% of patients after a course of endoscopic balloon dilatation, the lower esophageal sphincter resting pressure and the integrated relaxation pressure reached normal values.

Conclusion. Pneumodilatation can be complemented with hydrodilatation to improve the results of endoscopic treatment. Hydrodilatation can be used when combining achalasia cardia and cicatricial changes in the esophagogastric junction, as well as after operations on the cardia. To establish the type of achalasia, to predict and objectively evaluate the results of treatment, high-resolution manometry should be performed before and after endoscopic balloon dilatation of the cardia.

Study design: retrospective-prospective study.

Keywords:endoscopic dilatation of the cardia; pneumodilatation; hydrodilatation; achalasia cardia; cardiospasm; high-resolution manometry

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Bulganina N.A., Godzhello E.A., Khrustaleva M.V. Endoscopic balloon hydrodilation in the treatment of achalasia of the cardia. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (1): 41-52. DOI: https://doi.org/10.33029/2308-1198-2022-10-1-41-52  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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