Treatment of achalasia with the Witzel dilator: a prospective randomized study of two methods.
OBJECTIVE
Several studies have shown that the use of the Witzel dilator is an effective and safe treatment for achalasia. However, the optimal values for pressure, number of dilations, and duration of application have not yet been established. The aim of this study was to determine these three parameters.


METHODS
43 patients with a diagnosis of achalasia (based on clinical, radiological, manometric and endoscopic evaluation) were randomly allocated to one of two treatment groups. Patients in group A (n=21) underwent three consecutive 1-minute dilations per session at 1-minute intervals, at 200 mmHg for the first dilation and 300 mmHg for the second and third. In group B patients (n=22) only one dilation was done, at 200 mmHg for 2 minutes. Before and after treatment, the clinical score, the maximum esophageal diameter (obtained using barium contrast studies) and the basal pressure of the lower esophageal sphincter were evaluated in each patient. The need for further treatment and the presence of complications were also determined.


RESULTS
Both methods led to clinical, radiological, and manometric benefits. No differences were observed between the methods (satisfactory results in 86%; one perforation in each group). Six patients underwent operation; five for an incomplete response and one for a perforation.


CONCLUSIONS
There were no differences between the two groups investigated, suggesting that only one 2-minute dilation at 200 mmHg is sufficient.
Alonso-Aguirre
P
P
Department of Digestive Diseases, Hospital Juan Canalejo, La Coruña, Spain. alonso@medynet.com
Aba-Garrote
C
C
Estévez-Prieto
E
E
González-Conde
B
B
Vázquez-Iglesias
J L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome