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.
