More on dilatation

January 25, 2011

If anyone is interested in dilatation as a first treatment there is a

very good study that came out last fall.

Predictors for outcome of failure of balloon dilatation in patients with

achalasia

One of the reasons I like this study is that they do a good job of

pointing out the range of results of other studies for both dilatation

and myotomy and point out how comparing them can be like comparing

apples and oranges, not just in dilation compared to myotomy but

dilatation compared to dilatation. They then select studies to compare

apples to apples from both dilatation and myotomy studies. They show

that what they do produces results that are in line with studies on

myotomy.

Here is what they do. They use a graded dilatation (PD) of 30, 35 and

40mm balloons on three consecutive days. Earlier they did 40, 40, 40 and

later changed to the other. Graded over three days is going to be more

expensive than doing it in one day but they do report good success this

way.

Dilatation sometime gets a bad rap in this support group. That is

understandable because a lot of members have had poor results with it.

Which could be because many of them may not have had dilatation that was

aggressive enough. Too often dilatation is done with balloons that are

only half the size of true achalasia balloons, or a small achalasia

balloon is used but bigger ones may have been needed to fallow up the

smaller ones to get lasting results. So, oranges to apples, their bad

results may not mean much for someone that is considering graded

dilatation with real achalasia balloons.

Still there is the question of how much does dilatation effect the

results of myotomy later. What this study does try to answer is what

were the things that predicted dilatation failure in their patients. The

main one they found that matters before having dilatation done is age.

For them, as age before 50 was decreased the risk of achalasia symptom

recurrence was increased. There are graphs and tables of this kind of stuff.

If you wish to avoid the myotomy this is worth reading.

notan

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