In achalasia, disrupting the spastic muscle at the end of the esophagus (lower esophageal sphincter) can be done by using a balloon dilator. The achalasia balloon dilators are usually larger in diameter than regular dilators, starting at 30 millimeters (1.18 inches). They are positioned to overlay the hypertrophied lower esophageal sphincter and are then inflated to a preset size. A successful procedure leaves a controlled tear in the layers of the lower esophageal sphincter. The process will be repeated if necessary and the size of the balloon can be increased every time to reach satisfactory results.
The achalasia balloon dilation is done under direct visualization by X-ray (fluoroscopy). Endoscopic pneumatic dilation of the lower esophageal sphincter is the most effective nonsurgical treatment for achalasia. It is a generally safe procedure; the risk of esophageal perforation after balloon dilation was described in only 1.6 percent of the cases.
By Michel Kafrouni, M.D.