title: Witzel pneumatic dilation for achalasia: safety and long-term efficacy.
abstract: Forceful dilation of the lower esophageal sphincter is considered primary therapy for achalasia. The Witzel pneumatic balloon dilator, unlike fluoroscopically placed dilators, is placed over a standard gastroscope allowing positioning and dilation under direct vision. We report our experience with the Witzel dilator in 45 patients with achalasia over a 5-year period. All patients had at least one major symptom score of 8 out of 10 for dysphagia and/or regurgitation before dilation. After Witzel dilation, symptomatic response was graded as excellent (score 0 to 2), good (score 3 to 5), fair (score 6 to 8), and poor (no improvement). Symptom response was assessed after 1 week, 1 month, 6 month, 1 year, and present. The mean period of follow-up was 25 months (range, 3 to 85 months). Passage of the balloon across the gastroesophageal junction was technically unsuccessful in three patients. Esophageal perforation occurred in two patients (4%) and transient chest pain greater than 2 days in three patients (7%). There was no bleeding or death. Symptomatic long-term improvement was excellent in 25 patients (63%), good in 6 patients (15%), fair in 4 patients (10%), and poor in 5 patients (12%). A repeat Witzel dilation was performed in five patients but resulted in good/excellent improvement in only one patient. We conclude that pneumatic dilation with the Witzel balloon is a safe, effective procedure for achalasia.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor.
authors.forename: J L
authors.initials: JL
authors.lastname: Barnett
authors.forename: R
authors.initials: R
authors.lastname: Eisenman
authors.forename: T T
authors.initials: TT
authors.lastname: Nostrant
authors.forename: G H
authors.initials: GH
authors.lastname: Elta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation*; D004931:Esophageal Achalasia / Q000473:pathology / Q000628:therapy*; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged