ABSTRACT Aim of the work: Achalasia is a rare pathology whose physiopathogenesis is mysterious. The treatment is based on endoscopic pneumatic dilation (PD) and surgery. The aim of our work is to show our experiment about endoscopic pneumatic dilation as the principal treatment suggested for patients presenting achalasia. Material and method: It is a retrospective study relating 21 cases of achalasia indexed between 2002 and 2007. The remission was judged on Eckardt’s clinical criteria. If the symptoms persist after three episodes of PD, there’s a therapy failure and the patients were then proposed to surgery or recurrent DP. The results: The Middle Age at the time of diagnosis was of 44 ± 10, 66 years (20 to 76). The sex ratio was 1, 3 (12M?9F) (p = 0.5). The diagnosis of achalasia is based on imaging, endoscopy and manometric arguments. The PD of the cardia was proposed in first intention, except two patients who were treated 6 and 15 years before by surgery. 38 dilations were performed for 21 patients with an average of 1.8 PD per patient [1-6]. The rate of good answers after the third episode of PD was about 90.47% (19 patients). There was no complication of the PD. In plain-varied analysis, no predictive factor of good answers to PD was retained. Conclusion: PD is an effective cure with a negligible morbidity and no mortality. The surgery is reserved for the failures of pneumatic dilation.
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Yousfi, M. , Lahmidani, N. , Ibrahimi, A. and Benajah, D. (2012) The endoscopic pneumatic balloon dilation in treating achalasia in a Moroccan center. Open Journal of Gastroenterology, 2, 172-176. doi: 10.4236/ojgas.2012.24033.
 Spiess, A.E. and Kahrilas, P.J. (1998) Treating achalasia: From whalebone to laparoscope. The Journal of the American Medical Association, 28, 638-642. doi:10.1001/jama.280.7.638
Campos, G.M. (2009) Endoscopic and surgical treatments for achalasia: A systematic review and meta-analysis. Annals of Surgery, 249, 45-57. doi:10.1097/SLA.0b013e31818e43ab
Bittinger, M. and Wienbeck, M. (2001) Pneumatic dilation in achalasia. Canadian Journal of Gastroenterology, 15, 195-199.
Guardino, J.M., Vela, M.F., Connor, J.T. and Richter, J.E. (2004) Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. Journal of Clinical Gastroenterology, 38, 855-860. doi:10.1097/00004836-200411000-00004
Barkin, J.S., Guelrud, M., Reiner, D.K., Goldberg, R.I. and Phillips, R.S. (1990) Forceful balloon dilation: An outpatient procedure for achalasia. Gastrointestinal Endoscopy, 36, 123-126. doi:10.1016/S0016-5107(90)70964-9
Lambroza, A. and Schuman, R.W. (1995) Pneumatic dilation for achalasia without fluoroscopic guidance: Safety and efficacy. American Journal of Gastroenterology, 90, 1226-1229.
Sabharwal, T., Cowling, M., Dussek, J., Owen, W. and Adam, A. (2002) Balloon dilation for achalasia of the cardia: Experience in 76 patients. Radiology, 224, 719- 724. doi:10.1148/radiol.2243011049
Chan, K.C., Wong, S.K., Lee, D.W., Mui, W.L., Chan, A.C., Ng, E.K., et al. (2004) Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years’ experience. Endoscopy, 36, 690-694. doi:10.1055/s-2004-825659
Ghoshal, U.C., Chaudhuri, S., Pal, B.B., Dhar, K., Ray, G. and Banerjee, P.K. (2001) Randomized controlled trial of intrasphincteric botulinum toxin A injection versus balloon dilatation in treatment of achalasia cardia. Diseases of the Esophagus, 14, 227-231. doi:10.1046/j.1442-2050.2001.00189.x
Boztas, G., Mungan, Z., Ozdil, S., Akyüz, F., Karaca, C., Demir, K., et al. (2005) Pneumatic balloon dilatation in primary achalasia: The long-term follow-up results. Hepatogastroenterology, 52, 475-480.
Katsinelos, P., Kountouras, J., Paroutoglou, G., Beltsis, A., Zavos, C., Papaziogas, B., et al. (2005) Long-term results of pneumatic dilation for achalasia: A 15 years’ experience. World Journal of Gastroenterology, 11, 5701- 5705.
Gelfand, M.D. and Kozarek, R.A. (1989) An experience with polyethylene balloons for pneumatic dilation in achalasia. American Journal of Gastroenterology, 84, 924- 927.
Kadakia, S.C. and Wong, R.K. (1993) Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. American Journal of Gastroenterology, 88, 34-38.
Wehrmann, T., Jacobi, V., Jung, M., Lembcke, B. and Caspary, W.F. (1995) Pneumatic dilation in achalasia with a low-compliance balloon: Results of a 5-year prospective evaluation. Gastrointestinal Endoscopy, 42, 31- 36. doi:10.1016/S0016-5107(95)70239-3
 Dobrucali, A., Erzin, Y., Tuncer, M., Dirican, A., et al. (2004) Long-term results of graded pneumatic dilatation under endoscopic guidance in patients with primary eso-phageal achalasia. World Journal of Gastroenterology, 10, 3322-3327.
Khan, A.A., Shah, S.W., Alam, A., Butt, A.K., Shafqat, F. and Castell, D.O. (1998) Pneumatic balloon dilation in achalasia: A prospective comparison of balloon distention time. The American Journal of Gastroenterology, 93, 1064-1067. doi:10.1111/j.1572-0241.1998.00330.x
Mikaeli, J., Bishehsari, F., Montazeri, G., Yaghoobi, M. and Malekzadeh, R. (2004) Pneumatic balloon dilatation in achalasia: A prospective comparison of safety and efficacy with different balloon diameters. Alimentry Pharmacology & Therapeutics, 20, 431-436.
Rai, R.R., Shende, A., Joshi, A., Mathur, A. and Nijhawan, S. (2005) Rigiflex pneumatic dilation of achalasia without fluoroscopy: A novel office procedure. Gastro-intestinal Endoscopy, 62, 427-431. doi:10.1016/j.gie.2005.04.008
Ghoshal, U.C., Kumar, S., Saraswat, V.A., Aggarwal, R., Misra, A. and Choudhuri, G. (2004) Long-term follow-up after pneumatic dilation for achalasia cardia: Factors associated with treatment failure and recurrence. American Journal of Gastroenterology, 99, 2304-2310. doi:10.1111/j.1572-0241.2004.40099.x
Honein, K., Slim, R., Yaghi, C., Kheir, B., Bou Jaoudé, J. and Sayegh, R. (2007) Pneumatic dilatation of achalasia: Local experience in treating 41 patients. Lebanese Medical Journal, 55, 15-18.
Harish, K., Harikumar, R., Kumar, S. and Thomas, V. (2007) Efficacy and safety of Rigiflex pneumatic dilation of achalasia under direct endoscopy. Indian Journal of Gastroenterology, 26, 96-97.
Ponce, J., Garrigues, V., Pertejo, V., Sala, T. and Berenguer, J. (1996) Individual prediction of response to pneumatic dilation in patients with achalasia. Digestive Diseases and Sciences, 41, 2135-2141. doi:10.1007/BF02071392
Shimi, S., Nathanson, L.K. and Cuschieri, A. (1991) Laparoscopic cardiomyotomy for achalasia. Journal of the Royal College of Surgeons of Edinburgh, 36, 152-154.
Pellegrini, C., Wetter, L.A., Patti, M., et al. (1992) Thoracoscopic esophagomyotomy: Initial experience with a new approach for the treatment of achalasia. Annals of Surgery, 216, 291-296. doi:10.1097/00000658-199209000-00008
Zaninotto, G., Annese, V., Costantini, M., et al. (2004) Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Annals of Surgery, 239, 364-370. doi:10.1097/01.sla.0000114217.52941.c5