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Treatment of Achalasia with the Witzel Dilator: A Prospective Randomized Study of Two Methods

2003; Thieme Medical Publishers (Germany); Volume: 35; Issue: 5 Linguagem: Inglês

10.1055/s-2003-38777

1438-8812

Pedro Alonso-Aguirre, C. Aba-Garrote, Emilio Estévez-Prieto, Benito González-Conde, J. L. Vázquez-Iglesias,

Eosinophilic Esophagitis

The treatment of primary achalasia of the esophagus is basically palliative and is aimed at decreasing the lower esophageal sphincter (LES) pressure. Several approaches have been designed with this objective, from pharmacological treatment, such as smooth muscle fibre relaxants, to endoscopic therapies (intrasphincteric botulinum toxin injection [1], endoscopic sclerotheraphy [2], and forceful pneumatic dilation of the cardia), and surgical procedures (cardiomyotomy by laparotomy or laparoscopy). Among the nonpharmacological treatments, pneumatic dilation and surgical cardiomyotomy provide the best long-term results [3] [4] [5] [6]. Pneumatic dilation is the most cost-effective method [7], and also allows rapid recovery of the patient, can be performed as an outpatient procedure in many cases [8], and shows a lower incidence of post-treatment gastroesophageal reflux disease than surgery [3] [4] [9]. For these reasons, pneumatic dilation is considered by many to be the preferred approach [4] [7] [10]. Esophageal perforation, the complication causing the greatest concern, occurs in 2 - 6 % of cases [3] [11] [12] [13].