Achalasia or pseudoachalasia?

This 45 year old patient had been referred from another institution for balloon dilatation for achalasia of cardia. He had undergone an upper GI endoscopy and nothing unusual had been discovered. A barium swallow showed the classic bird beak lower esophagus (A: green arrow). The manometric findings also suggested classic achalasia. When we went in to dilate and retroflexed to view the fundus prior to wire insertion, the esophago-gastric junction was seen to be ulcerated and indurated (B:green arrow). We took biopsies (C: green arrow) and cancelled the dilatation till the biopsy report and a CT scan of the lower chest and abdomen.

Achalasia of the cardia in a 52 year old gentleman

Achalasia of the cardia. A Rigiflex balloon was passed under flouroscopic guidance. Initial inflation showed the waist at the level of the lower esophageal sphincter (A:green arrow). Full obliteration of the waist was seen after full inflation (B: green arrow). Our departmental experience is that inflation for 6 seconds is good enough. Pressure was 8psi. No leakage of contrast seen on post dilatation barium swallow (C: green arrows showing area of interest).

Balloon dilatation for achalasia of cardia

Achalasia of the cardia. We used a Rigiflex balloon to dilate it. The first image (A) shows the waist of the balloon at the lower esophageal sphincter. The second image shows obliteration of the waist after balloon dilatation (B). Following dilatation the standard protocol barium swallow showed no leakage of contrast material (C). Dotted green arrows showing the areas of interest.