Cortellini, FabioShoshan, DiklaAzzaroli, FrancescoTorresan, FrancescoMandolesi, DanieleDe Giorgio, RobertoBazzoli, FrancoMularoni, CeciliaIoannou, AlexandrosKaramanolis, GeorgeBackground The efficacy of pneumatic dilation (PD) in the management of achalasia has yielded variable results. The availability of high-resolution manometry led to the identification of 3 clinically relevant subtypes of achalasia, revealing the poor efficacy of PD in subtype III. Furthermore, PD showed a lower response rate in patients with subtype III compared to laparoscopic Heller myotomy and peroral endoscopic myotomy. This study aimed to investigate the short- and longterm efficacy, safety profile and side effects of PD with a “graded approach” in subtypes I and II  achalasia. Methods We enrolled 141 patients (male 67, mean age=66±16.26 years) with achalasia (n=27 subtype I, n=74 subtype II and n=40 subtype III) between January 2010 and July 2020 at St. Orsola University Hospital, Bologna, Italy. We analyzed the data of patients with subtypes I and II, who underwent a graded-protocol PD. Short- and long-term clinical efficacy, complications and gastroesophageal reflux disease (GERD) were recorded. Results One month after graded protocol PD, 100% subtype I and 96.2% subtype II achalasia patients showed clinical remission. The PD procedure was completed without major complications in all patients. In the long-term follow up (median time: 56 months), 95.5% subtype I and 90% subtype II achalasia patients had an Eckardt score ≤3. GERD occurred in 27.7% of all patients. Conclusion A graded-protocol PD applied in the appropriate achalasia subtypes was shown to be a safe and highly effective approach, in both the short- and long-term. Keywords Esophageal achalasia, pneumatic dilation, Heller myotomy, endoscopic gastrointestinal surgery, high-resolution manometry Ann Gastroenterol 2022; 35 (1): 28-33text/htmlapplication/pdfhttp://www.annalsgastro.gr/index.php/annalsgastro/article/view/6281engHellenic Society of GastroenterologyCopyright (c) 2022 Annals of Gastroenterology1792-74631108-7471Annals of Gastroenterology; Volume 35, No 1 (2022); 28Graded pneumatic dilation in subtype I and II achalasia: long-term experience in a single centerinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion2022-01-10Δημοσίευση σε περιοδικόPublication in journalΓαστροεντερολογίαGastroenterologyisi -Gastroenterology & Hepatology covers resources on the anatomy, physiology, biochemistry, and pathology of the digestive system. This category includes specific resources on the prognosis and treatment of digestive diseases; stomach ulcers; metabolic, genetic, infectious and chemically induced diseases of the liver; colitis; diseases of the pancreas and diseases of the rectum.Επιστημονικό άρθροScientific articleΕλληνική Γαστροεντερολογική ΕταιρίαGreek Aggregator OpenArchives.gr | National Documentation Centre (EKT)other