From the Guidelines
The best method for esophageal dilatation is to use pneumatic balloons 30–40 mm in diameter, starting at 30 mm in the first session, to reduce the risk of complications, as recommended by the most recent and highest quality study 1. This approach is supported by the UK guidelines on oesophageal dilatation in clinical practice, which suggest that pneumatic balloon dilatation is an effective treatment for achalasia, with a high grade of evidence and strong recommendation 1. The procedure typically involves:
- Performing dilatation under endoscopic or fluoroscopic control, based on clinician’s preference and local expertise 1
- Considering proton pump inhibitor (PPI) therapy after dilatation to prevent symptomatic gastro-oesophageal reflux disease (GORD) or ulcerative oesophagitis, which can occur in 10-40% of patients 1
- Performing a second dilatation session 2-28 days later with a larger size balloon of 35 mm, and considering repeat dilatation during follow-up to maintain symptom response 1 Some key points to consider when performing esophageal dilatation include:
- The choice between bougie and balloon methods ultimately depends on operator experience, stricture characteristics, and equipment availability 1
- There is no difference in clinical outcomes between wire-guided bougie and balloon dilators, and the choice should be based on clinician’s preference, local expertise, equipment availability, cost, and the availability of robust methods of decontamination of reusable medical devices 1
- Balloon dilators allow the procedure to be performed under direct vision, but are more costly than push dilators 1 It is essential to prioritize the patient's safety and well-being during the procedure, and to monitor for signs of perforation, such as chest pain, fever, and subcutaneous emphysema, and to advance the patient's diet gradually after the procedure.
From the Research
Esophageal Dilatation Methods
- Balloon dilatation is a safe and effective method for treating esophageal strictures, as shown in studies 2, 3, 4
- This method can be used in both adults and children, with minimal trauma and morbidity 2, 3
- Balloon dilatation has been found to have a low perforation and mortality rate, making it a preferred primary treatment method 4
Comparison of Dilatation Methods
- A systematic review and meta-analysis found no difference between bougie and balloon dilation in terms of symptomatic relief, recurrence rate, bleeding, and perforation 5
- However, patients undergoing balloon dilation reported less severe postprocedure pain 5
- Another study introduced a novel balloon pull-through technique for esophageal dilation in eosinophilic esophagitis, which appeared to be safe and effective 6
Specific Patient Groups
- Balloon dilatation has been found to be effective in children with esophageal strictures, with few complications 3, 4
- In patients with eosinophilic esophagitis, the balloon pull-through technique has been shown to be a rational approach to gauging the luminal diameter of the esophagus and treating strictures 6