2026 Volume 62 Issue 1 Pages 54-60
The patient was a 5-year-old boy who started vomiting five months earlier and became worse during the last three weeks, concomitantly with upper respiratory tract inflammation. Chest computed tomography scan revealed total esophageal dilation, which indicated esophageal achalasia. Delayed esophageal emptying of contrast medium was noted on esophagography, and the integrated relaxation pressure of the lower esophageal sphincter was high (16.7 mmHg) on high-resolution manometry. On the basis of these findings, the patient was diagnosed as having type I (Chicago classification) esophageal achalasia. His preoperative Eckardt score was 4. Three balloon dilatations were performed up to 30 mm in incremental steps. His symptom was resolved, and he was discharged three days after the last operation. After discharge, he occasionally had exacerbated vomiting. We performed additional balloon dilation 14 months after the first operation, which was chosen over laparoscopic Heller myotomy, which was considered over-invasive for his Eckardt score of 1 (regurgitation), after which he showed no difficulty with food intake, and he gained weight. Sixteen months after the first operation, he tolerated a regular diet with a body weight gain of 7 kg.
