ASGE Endoscopy Live: Management of Achalasia | April 2023-Case Demonstration 3

Video Transcription

Video Summary

In the video, Dr. Michael Bezzi from Vanderbilt University Medical Center demonstrates a pneumatic dilation procedure for a patient with achylasia. He is assisted by Dr. Patel and Dr. Naik. They discuss the case of a 49-year-old female with dysphagia to solids and liquids, classic symptoms of achylasia. The patient had undergone multiple endoscopies with dilation at an outside hospital without improvement. They perform a barium esophagram and esophageal manometry, which confirms the diagnosis of achylasia, specifically a type 2 pattern. They discuss the treatment options and determine that pneumatic dilation would be suitable based on the patient's factors. They explain the procedure and demonstrate the use of a three-centimeter balloon for dilation. They emphasize the importance of proper positioning and inflation of the balloon to ensure efficacy. Throughout the procedure, they highlight the use of endoscopic guidance instead of fluoroscopy, which they find to be equally effective and safer. They also discuss potential complications such as perforation and mention the availability of fully covered stents in case of a tear. They conclude the procedure by examining the post-dilation area and discussing post-procedure monitoring and follow-up. They also briefly discuss when to consider larger balloon sizes and the preference for POEM in certain patient populations. The video ends with acknowledgements to the medical team and ASGE for the opportunity to share their technique.

Keywords

video

Dr. Michael Bezzi

Vanderbilt University Medical Center

pneumatic dilation procedure

achylasia

Dr. Patel

Dr. Naik