M CECUM THE CECU HING THE REACHING REAC By Robert E. Kravetz, MD, MACG Scottsdale, AZ
A LOOK BACK
PNEUMATIC DILATOR for ACHALASIA
A
This archival reflection originally appeared in The American Journal of Gastroenterology in May 2002.
chalasia is a common motor disorder of the esophagus that was first described by Sir Thomas Willis in London in 1674. He used a whale bone attached to a sponge to dilate his patient. Von Mikulicz in 1881 believed that there was a spasm at the cardia; the entity was labeled cardiospasm. In 1937, Lendum noted incomplete relaxation of the lower esophageal sphincter, which was named achalasia, the term in current use. Forceful dilation that tears the circular muscles of the esophagus is necessary to achieve a lasting effect. In 1924, Starck, a German physician, utilized a mechanical dilator with expanding metal arms, but its popularity was brief. Hydrostatic balloon dilators filled with water were popular in Europe, but the standard therapy became forceful pneumatic balloon dilation. The first
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pneumatic dilator was described by Mosher in 1923. Several other pneumatic dilators have been used since that time with both success and complications. Currently cylindrical air-filled balloon Rigid-flex dilators passed over a guidewire are most popular. The Mosher style pneumatic dilator illustrated here dates from the 1950s. It consists of a flexible metalspring perforated bougie tip that is passed into the stomach. The rubber-covered silk bag is placed at the esophagogastric junction. A metal and whale bone staff is used for introduction of the bag, and an inflating bulb and gauge to measure pressure. The complication rate confined to larger perforations has remained constant over the years.
