Endoscopy 2016; 48(02): 128-133
DOI: 10.1055/s-0034-1392860
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Utility of clinical suspicion and endoscopic re-examination for detection of esophagogastric perforation after pneumatic dilation for achalasia

Andreas G. Zori
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
,
Tejas S. Kirtane
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
,
Anand R. Gupte
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
,
Shailendra S. Chauhan
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
,
Peter V. Draganov
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
,
Chris E. Forsmark
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
,
Mihir S. Wagh
Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
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Publikationsverlauf

submitted 16. Dezember 2014

accepted after revision 08. Juli 2015

Publikationsdatum:
21. September 2015 (online)

Background and study aims: Esophagrams are often obtained routinely after pneumatic balloon dilation for achalasia, even in asymptomatic patients, as there is a risk of postprocedure esophagogastric perforation, which is a potentially life-threatening complication. The aim of this study was to determine whether the combination of a clinical suspicion of perforation and endoscopic re-examination after pneumatic dilation for achalasia can detect esophagogastric perforation, and thereby preclude the need for routine esophagrams in all patients.

Patients and methods: All patients who underwent pneumatic dilation between January 2002 and June 2012 at our single tertiary referral center were identified retrospectively. Procedures were categorized into two groups: Group 1 underwent routine esophagograms after pneumatic dilation, and Group 2 underwent esophagograms only if there was a clinical suspicion of perforation. The detection rate of esophageal perforation after pneumatic dilation was compared between the two groups.

Results: A total of 119 achalasia dilation procedures were performed in 70 patients. Group 1 included 49/119 procedures (41.2 %), all of which were followed by routine esophagograms. Group 2 included 70/119 procedures (58.8 %), 12 of which were followed by esophagograms based on a clinical suspicion of perforation. No esophageal perforations were found in Group 1, whereas three were found in Group 2. No perforations occurred in the 58 procedures that were not followed by esophagograms. The overall rate of perforation was 3/119 (2.5 %).

Conclusions: Esophagrams obtained routinely after pneumatic dilation for achalasia did not reveal unsuspected esophagogastric perforations. No esophageal perforations were missed after procedures that were not followed by esophagograms. Obtaining an esophagram only in cases of clinical suspicion of perforation and endoscopic evaluation may be an alternative to routine esophagograms in patients undergoing pneumatic dilation for achalasia.

 
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