Efficacy and Predictors of Success of Esophageal Hydraulic Balloon Dilation in Patients With and Without Previous Foregut Surgery

Background and Aims: The advantages of esophageal hydraulic balloon dilation include the ability to dilate up to 30 mm without fluoroscopic guidance and real-time display of the esophagogastric junction diameter during dilation. We aimed to explore the safety and efficacy of esophageal hydraulic balloon dilation in patients with and without previous foregut surgery, as well as to evaluate for predictors of clinical success. Methods: We reviewed our database for patients who had esophageal hydraulic balloon dilation, and patients were divided into those with and without previous foregut surgery. Clinical success was determined by improvement in Eckardt/Brief Esophageal Dysphagia Questionnaire scores or, if not available, by physician assessment documented in the medical records. Technical success was defined as the ability to successfully perform esophageal hydraulic balloon dilation with visualization of the waist and stabilization of the balloon. Univariate analysis and logistic regression were used to evaluate predictors of clinical success after dilation. Results: Among 80 patients who had esophageal hydraulic balloon dilation (36 without and 44 with previous foregut surgery), clinical success was achieved in 48% of patients without previous foregut surgery (43% in achalasia and 73% in esophagogastric junction outflow obstruction) and 83% of patients with previous foregut surgery (87% in surgically treated achalasia and 80% in patients without achalasia with previous fundoplication). Technical success was achieved in 86% of patients without previous foregut surgery and 98% in patients with previous foregut surgery. There was 1 esophageal perforation (1.3%). Opiate use was a negative predictor of clinical success. Conclusion: Clinical success rates after esophageal hydraulic balloon dilation differ depending on the patient's foregut surgery history. Opiate users appear to have a lower clinical success rate compared with nonusers.