Rigiflex pneumatic dilation of achalasia without fluoroscopy: a novel office procedure.
BACKGROUND: Pneumatic balloon dilation is the most effective nonsurgical treatment to relieve functional obstruction of the gastroesophageal junction in achalasia. Since its inception, the conventional technique has been performed under direct fluoroscopic control with or without a guidewire. To overcome the impediments of the conventional technique and radiation exposure, we have devised a novel technique of achalasia dilation without fluoroscopy. The aim of the study was to evaluate the efficacy, the safety, and the outcome of the new method. METHODS: Fifty-six patients (34 men, 22 women) (mean age 32 years) with achalasia cardia were subjected, over a span of 2 years, to dilation with a Gruntzig-type (Rigiflex balloon) pneumatic dilator with the new technique. Clinical response and complications were assessed. OBSERVATIONS: Excellent improvement in dysphagia, pain, and regurgitation was observed in 92.9%, 89.3%, and 89.3% patients at 24 hours, 6 weeks, and 6 months after dilation, respectively. The mean time to maneuver the Rigiflex balloon to the antrum was 30 seconds. The procedure was successfully done in all patients, and there were no procedural failures. The mean time of the procedure was 8 minutes. There were no complications or mortality during the study. CONCLUSIONS: Achalasia dilation with this new technique has excellent results and is devoid of the side effects of radiation. It can be done as an office procedure, without the need of a fluoroscopy setup.