title: Massively dilated esophagus in achalasia: response to pneumatic balloon dilation.
abstract: OBJECTIVE
  Pneumatic balloon dilation is considered by many to be the treatment of choice for achalasia of the esophagus. Patients with untreated, long standing achalasia may develop massively dilated esophagi, sometimes difficult to dilate with a pneumatic balloon and, rarely, may require esophagectomy. We present our experience with nine such patients out of 110 who underwent pneumatic dilation.
  
  
  METHODS
  Of 110 patients treated for achalasia by pneumatic balloon dilation, from January 1989 until December 1996, nine patients had massively dilated esophagi with transverse diameter >7 cm. Results of these patients are presented with pre- and postdilation symptom scores and barium esophagograms. This study was conducted at the Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan. A Microvasive Rigiflex 35 mm (Boston Scientific, Watertown, MA) pneumatic balloon was used for dilation.
  
  
  RESULTS
  Although it is often tedious to perform pneumatic dilation in massively dilated esophagus, it was possible to dilate adequately, in all nine cases without complications, with good symptomatic improvement at 12-month follow-up.
  
  
  CONCLUSIONS
  We recommend pneumatic balloon dilation in achalasia with massively dilated esophagus as a first line treatment, the failure of which requires surgical intervention.
authors.affiliation: Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan.
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.forename: S W
authors.initials: SW
authors.lastname: Shah
authors.forename: A
authors.initials: A
authors.lastname: Alam
authors.forename: A K
authors.initials: AK
authors.lastname: Butt
authors.forename: F
authors.initials: F
authors.lastname: Shafqat
authors.forename: D O
authors.initials: DO
authors.lastname: Castell
mesh_terms: D000328:Adult; D002404:Catheterization; D004108:Dilatation, Pathologic; D004931:Esophageal Achalasia / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged