Efficacy and Safety of the Side-by-Side (SBS) Method for Balloon Dilation in Achalasia Refractory to POEM

Aims Endoscopic balloon dilation is an established treatment for benign gastrointestinal strictures, requiring gradual and safe dilation under direct endoscopic visualization. However, achieving dilation widths of 20–30 mm with standard devices and over 30 mm under endoscopic visualization remains challenging. For achalasia cases with suboptimal response to peroral endoscopic myotomy (POEM), innovative techniques are necessary to safely achieve greater dilation widths. We have developed the Side-by-Side (SBS) method (Digestive Endoscopy, 2022), which enables dilation beyond 21 mm while maintaining direct visualization. This study evaluates the safety and efficacy of the SBS method in patients with insufficient symptom control following POEM [1].

Methods Between February 2022 and July 2024, 27 patients with refractory symptoms post-POEM underwent SBS balloon dilation at our institution. In this technique, a dilation balloon is introduced alongside a therapeutic endoscope (single-barrel), and for greater widths, a second balloon may be added (double-barrel). Clinical outcomes were assessed by comparing pre- and post-procedure Eckardt scores, and the incidence of adverse events was documented.

Results The SBS method significantly improved Eckardt scores from 3.16 to 1.71 (p<0.0001). Eight patients (29.6%) required multiple procedures, with two cases (7.4%) requiring repeat dilations every 2–3 months to maintain symptom control. One patient with insufficient response to SBS underwent re-POEM. No adverse events were observed. The double-barrel method theoretically achieved dilation widths exceeding 30 mm.

Conclusions The SBS method, combining single-barrel and double-barrel techniques, is a safe and effective approach for achieving gradual and controlled dilation under direct visualization. This method may be particularly beneficial for esophagogastric junction strictures, such as achalasia refractory to POEM.

Publication History

Article published online:
27 March 2025

• References

• 1 Toshimori A, Inoue H, Fujiyoshi MRA. et al. Novel modified side-by-side balloon dilatation method for esophagogastric junction strictures: Single-/double-barrel techniques. Dig Endosc 2022; 34 (03): 641-647