title: [Pneumatic dilation in the treatment of achalasia].
abstract: BACKGROUND
  Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences.
  
  
  OBJECTIVE
  To review the experience of pneumatic dilation in patients with achalasia in our center.
  
  
  METHODS
  We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex(®) balloon, usually at pressures of 250, 250 and 300mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications.
  
  
  RESULTS
  A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53±17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23±43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86±5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications.
  
  
  CONCLUSIONS
  In our series, pneumatic dilation had a high success rate. In most patients, a single session was required and the complications rate was low. These results show that this technique is safe and effective in these patients, avoiding a large number of surgical interventions.
authors: Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España. Electronic address: patriciaruizcuesta@hotmail.com.
authors: Patricia
authors: P
authors: Ruiz Cuesta
authors: Antonio José
authors: AJ
authors: Hervás Molina
authors: Juan
authors: J
authors: Jurado García
authors: María
authors: M
authors: Pleguezuelo Navarro
authors: Valle
authors: V
authors: García Sánchez
authors: Luis L
authors: LL
authors: Casáis Juanena
authors: Carmen
authors: C
authors: Gálvez Calderón
authors: Antonio
authors: A
authors: Naranjo Rodríguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation / Q000295:instrumentation / Q000379:methods; D004931:Esophageal Achalasia / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acalasia; Achalasia; Dilatación neumática; Miotomía quirúrgica; Pneumatic dilatation; Surgical myotomy