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Conservative Management of Esophageal Perforations During Pneumatic Dilation for Idiopathic Esophageal Achalasia.
- Source :
- Clinical Gastroenterology & Hepatology; Feb2012, Vol. 10 Issue 2, p142-149, 8p
- Publication Year :
- 2012
-
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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 15423565
- Volume :
- 10
- Issue :
- 2
- Database :
- Supplemental Index
- Journal :
- Clinical Gastroenterology & Hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 71274087
- Full Text :
- https://doi.org/10.1016/j.cgh.2011.10.032