Q: What is the differential for "balloon-like" dilatation of the distal oesophagus? show answer
"Ballooning" of the distal oesophagus after Heller myotomy
Routine follow up examination post Heller myotomy and Dor fundoplication.
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These images demonstrate mild "ballooning" of the distal oesophagus after a Heller myotomy, a normal finding.
Clips around the gatro-oesophageal junction are from the myotomy-fundoplication procedure.
Oesophageal myotomy (e.g. Heller myotomy) is performed to relieve the unrelenting pressure of a lower oesophageal sphincter than is incapable of relaxing (such as in achalasia). There are many different ways to perform the surgery, but most involve the creation of a new "pseudo" lower oesophageal sphincter by wrapping the gastric fundus around the lower oesophagus ("fundoplication").
Over time, the distal oesophagus may "balloon" out proximally to the fundoplication, through the fundoplication (as above). This occurs in ~50% of patients. This finding is important to communicate to the referring physician, but may be asymptomatic and intervention may not be necessary.
The most important thing is to recognize this as an expected finding and to not assume it is an epiphrenic diverticulum or failure of the myotomy to relieve the achalasia.
- 1. Rubesin SE, Kennedy M, Levine MS et-al. Distal esophageal ballooning following Heller myotomy. Radiology. 1988;167 (2): 345-7. doi:10.1148/radiology.167.2.3357942 - Pubmed citation
- 2. Barker JR, Franklin RH. Heller's operation for achalasia of the cardia. A study of the early and late results. Br J Surg. 1971;58 (6): 466-8. Pubmed citation