Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia.

Abstract

BACKGROUND & AIMS:

Esophageal perforation is the most serious adverse event of pneumatic dilation (PD) for achalasia; it is usually managed by surgical repair. We investigated risk factors for esophageal perforation after PD and evaluated safety and long-term outcome of nonsurgical management strategies.

METHODS:

We analyzed medical records of patients with achalasia who were treated with PD from 1992-2010 at the University Hospital Gasthuisberg in Leuven, Belgium; all patients with esophageal perforation were contacted to determine long-term outcomes. Achalasia outcomes were assessed by using the Vantrappen criteria.

RESULTS:

Of 830 PD procedures performed on 372 patients with manometry-confirmed achalasia (57 ± 1 years, 51% male), 16 were complicated by transmural esophageal perforation (4.3% of patients, 1.9% of dilations). Age >65 years was the only significant risk factor for complications (odds ratio, 3.5; 95% confidence interval, 1.2-10.2). All patients were treated conservatively with broad-spectrum antibiotics and nothing by mouth. In 6 patients (38%) the clinical course was further complicated by a pleural effusion, which required a drain in 4 patients. One patient (6%) died of mediastinal hemorrhage within 12 hours after PD. Patients with complications were discharged after 19 ± 2.3 days, compared with 4 ± 0.2 days for those without complications (P < .0001). Long-term outcomes (mean follow-up, 84 ± 14 months) were determined for 12 patients (75%); 11 had excellent or good outcomes (69%), and 1 had a moderate outcome (6%).

CONCLUSIONS:

Age >65 years is a significant risk factor for esophageal perforation after PD. Nonsurgical management of transmural esophageal tears is feasible, with favorable short-term and long-term outcomes, but is not devoid of complications.

• Authors: Tim Vanuytsel, Toni Lerut, Willy Coosemans, Dirk Vanbeckevoort, Kathleen Blondeau, Guy Boeckxstaens, Jan Tack
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 10 Issue 2 Pg. 142-9 (Feb 2012) ISSN: 1542-7714 [Electronic] United States
• PMID: 22064041 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Age Factors
• Aged
• Anti-Bacterial Agents (administration & dosage)
• Belgium
• Dilatation (adverse effects)
• Esophageal Achalasia (complications, therapy)
• Esophageal Perforation (drug therapy, epidemiology)
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Risk Factors
• Survival Analysis
• Treatment Outcome