GASTROENTEROLOGY ARTICLE OF THE WEEK
September 30, 2004
Wong RKH. The Expert’s Corner: Pneumatic dilation for achalasia Am J Gastroenterol 2004;99:578-80
1. Prognostic factors after pneumatic dilation predicting a good response include
a. blood on the dilator
b. rapid emptying of gastrograffin from the esophagus
c. a lot of pain during dilation
d. obliteration of the balloon waist during dilation
True or False
2. After inserting the guidewire, air should be removed from the stomach to facilitate fluoroscopic visualization of the EGJ.
3. For severe achalasia, the initial balloon used should be 3.5 or 4 cm.
4. Curling of the dilator over the guidewire in the esophagus can occur in patients with sigmoid esophagus, pulling back the guidewire while advancing the dilator helps.
5. After dilation, a barium swallow will help determine if perforation has occurred.
6. The diaphragmatic indentation should be placed in the middle of the balloon.
7. This expert’s opinion suggests keeping the bag inflated for 60 seconds (Did you notice that Dr. Clark?!?!”)
8. Repeat dilation should be done in 1-2 weeks if symptoms persist.