Non-surgical treatment of esophageal perforation after pneumatic dilation for achalasia: a case series

Abstract

Esophageal perforation is the most serious complication of pneumatic dilation for achalasia and is traditionally managed by conservative therapy or surgical repair. We present four achalasia patients who underwent pneumatic dilatation, complicated by an esophageal perforation. All patients were treated successfully with endoscopic treatment: two patients with Eso-SPONGE^® vacuum therapy, in the other two patients, esophageal defects were closed endoscopically using Endoclips. The time between dilatation and detection of the perforation was less than 24 h in all cases. Non-surgical treatment resulted in a relatively short hospital stay, ranging from 5 to 10 days, and an uneventful recovery in all patients. Based on our experience, endoscopic clipping and/or vacuum therapy are relatively new, valuable, minimally invasive techniques in the management of patients with small, well-defined esophageal tears with contained leakage and should be considered as primary therapeutic option for iatrogenic perforation in achalasia.

Keywords:

• Achalasia
• esophageal
• perforation pneumatic dilation
• endoscopic treatment

Disclosure statement

R.O.N., J.B., and B.T. have no competing interests. A.B. received research funding from Nutricia, Norgine and Bayer and received speaker and/or consulting fees from Laborie, EsoCap, Diversatek, Medtronic, Dr. Falk Pharma, Calypso Biotech, Thelial, Robarts, Reckett Benkiser, Regeneron, Celgene, Bayer, Norgine, AstraZeneca, Almirall and, Allergan. P.F. received research funding from Boston Scientific and received speaker and/or consulting fees fom Olympus, Cook, and Fujifilm.

Informed consent

Informed consent was obtained for publication of patient information.

Author contributions

Guarantor of the article: Renske A.B. Oude Nijhuis, MD. Specific author contributions: R.O.N. was involved in the acquisition of patient data. R.O.N, and A.B. had a role in collecting and/or interpreting data, and drafting the manuscript. A.B, B.T, P.F and J.B. had a role in reviewing and revising the manuscript for important intellectual content. All authors approved the final draft submitted.