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DOI: 10.1055/s-2007-963558
© Georg Thieme Verlag KG Stuttgart · New York
Incidence, Clinical Management and Outcomes of Esophageal Perforations after Endoscopic Dilatation
Inzidenz, Management und Verlauf von Perforationen des Ösophagus nach endoskopischer DilatationPublication History
manuscript received: 13.7.2007
manuscript accepted: 5.9.2007
Publication Date:
19 November 2007 (online)
![](https://www.thieme-connect.de/media/zfg/200711/lookinside/thumbnails/10.1055-s-2007-963558-1.jpg)
Zusammenfassung
Einleitung: Endoskopische Dilatationen werden bei der Behandlung von anatomischen und selten funktionellen Stenosierungen des Ösophagus eingesetzt, die durch eine Vielzahl von benignen oder malignen Prozessen verursacht sein können. Die Ösophagusperforation ist dabei die bedeutendste, assoziierte Komplikation. Ziele: Bestimmung der Inzidenz von Perforationen nach endoskopischer Dilatation des Ösophagus, ihr Management und ihr Verlauf. Methodik: Alle Patienten, die in unserem Zentrum von Juni 2001 bis Dezember 2006 eine endoskopische Ösophagusdilatation erhielten, wurden prospektiv mittels elektronischer Datenbanksuche identifiziert und analysiert. Ergebnis: In dieser Studie wurden 248 Patienten (148 Männer; 100 Frauen; Altersmedian 58, Range 14 - 87), die insgesamt 365 Ösophagusdilatationen erhielten, eingeschlossen: 74 pneumatische Ballondilatationen bei Achalasie, 79 Ballondilatationen bei anderen Gründen, wie zum Beispiel aufgrund von Tumoren, peptischen oder postradiogenen Stenosen, und 212 Dilatationen erfolgten mit Savary-Bougies. Die gesamte Inzidenz an Perforationen, basierend auf der Anzahl der durchgeführten Prozeduren, betrug 2,2 % (8 Perforationen/ 365 Behandlungen). Bezogen auf die Gesamtzahl der betrachteten Patienten betrug die Perforationsrate 3,2 % (8 / 248 Patienten). Die Perforationsrate betrug 1,9 % bei Bougie-Dilatation, 0 % bei Ballondilatation und 5,4 % bei pneumatischer Ballondilatation aufgrund einer Achalasie. Fünf der betroffenen Patienten erhielten eine operative Versorgung, während drei Patienten konservativ behandelt wurden. Die mittlere Krankenhausverweildauer betrug 14 Tage (7 - 33). Ein Patient, bei dem die Perforation erst 16 Tage nach der Dilatation erkannt wurde, verstarb. Schlussfolgerung: Die endoskopische Ösophagusdilatation ist eine sichere Methode zur Behandlung sowohl von malignen als auch von benignen Stenosierungen des Ösophagus sowie bei Patienten mit einer Achalasie. Die Perforationsrate nach diesen Behandlungen ist gering und der Benefit des Patienten überwiegt gegenüber den Komplikationen. Die frühe Erkennung einer Perforation ist mit einem besseren Outcome für den Patienten verbunden und kleine Perforationen können konservativ behandelt werden.
Abstract
Background: Esophageal dilatation is performed for the treatment of anatomic and sometimes functional narrowing of the esophageal lumen caused by a variety of benign and malignant conditions. Esophageal perforation is the major complication associated with endoscopic dilatation. Aim: The object of this study was to assess the incidence of perforation, management and outcomes after endoscopic esophageal dilatation. Methods: All patients who underwent endoscopic esophageal dilatation at our institution from June 2001 to December 2006 were identified. Data were obtained by searching our prospectively collected electronic database (MEDOS AG, Langenselbold, Germany), which includes all endoscopic reports as well as discharge summaries of patients who have undergone endoscopy in our department. Results: 248 patients (148 male, 100 female, mean age 58 years, range 14 - 87 years) underwent 365 esophageal dilatations: 74 pneumatic balloon dilatations for achalasia, 79 balloon dilatations for other reasons such as tumors, peptic stenosis, or post-radiotherapy stenosis and 212 dilatations with Savary bougies. The overall incidence of perforation based on the number of procedures was 2.2 % (8 perforations/ 365 procedures) and 3.2 % (8 / 248 patients) based on the number of patients. The perforation rate was 1.9 % for bougie dilatation, 0 % for balloon dilatation and 5 - 4 % for pneumatic balloon dilatation for achalasia. Five patients were treated surgically and 3 patients were managed conservatively. The mean hospital stay was 14 days (7 - 33 days). One patient in whom the perforation was recognized 16 days after the dilatation died. Conclusions: Endoscopic esophageal dilatation is a safe procedure for the palliation of malignant strictures, for the management of benign strictures as well as for the therapy of achalasia. The perforation rate after these procedures is low. Early recognition of the perforation is associated with a good outcome. Small perforations can be treated conservatively.
Schlüsselwörter
endoskopische Ösophagusdilatation - Ösophagusperforation - Ösophagusstenose
Key words
endoscopic esophageal dilatation - esophagus perforation - esophageal stenosis
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Klaus Mönkemüller, MD
Department of Gastroenterology, Hepatology and Infectious Diseases, Universitätsklinikum Magdeburg, Otto-von-Guericke University
Leipziger Straße 44
39120 Magdeburg
Germany
Phone: ++ 49/3 91/6 71 31 00
Fax: ++ 49/3 91/6 71 31 05
Email: Klaus.Moenkemueller@medizin.uni-magdeburg.de