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

Figures & data

Table 1. Clinical characteristics and course of treatment of esophageal perforation in four cases.

Case	Sex/ age	BMI	Weight loss > 10 kg	Symptom duration (years)	Achalasia type	IRP-4 (mmHg)	Barium Column height at 5 min (cm)	Esophageal width (cm)	Balloon size (mm)	Dilation pressure (PSI)	Site of perforation	Distance to EGJ (cm)	Length of perforation (cm)	Time until diagnosis (hours)	Extraluminal contrast on CT	Type of treatment	Hospital stay (days)	Treatment success
I	F/39	22	+	<1	1	22	3.7	3.0	40	8	Distal, L	5	3	12	Contained	EsoSPONGE	10	+
II	F/55	21	+	2	2	37	6.7	3.2	40	8	Distal, V	3	3	0	Contained	EndoClips  + esoSPONGE	7	+
III	F/70	20	+	<1	1	24	10.0	1.5	40	8	Distal, L	1	5	3	No extraluminal contrast*	EndoClips	5	+
IV	F/80	32	–	10	2	¥	2.6	4.3	35	8	Distal, R	1	4	0	Contained	EndoClips	6	+

EGJ: esophagogastric junction; I: Integrated relaxation pressure; L: left; R: right; V: ventral. *After endoscopic closure with Endoclips. ^¥Catheter did not pass the LES; therefore, IRP could not be calculated.

Figure 1. (a–c) Endoscopic view of the esophageal defect in case II. Immediately after pneumatic dilatation, a laceration 3 cm above the Z-line was observed (a). The patient was treated with Eso-SPONGE^® vacuum therapy (b). After 5 days, endoscopic inspection showed healing of the esophageal wall defect with granulation tissue (c).

Figure 2. (a–c) Endoscopic images of esophageal perforation in case III. The defect was located just above the esophagogastric junction (a) and was successfully closed with 15 endoclips (b and c).

Figure 3. Axial (a) and coronal (b) CT scan of the chest showing evidence of contained esophageal perforation on the right side of the distal esophagus in case IV, including extraluminal air and contrast (arrows).