Conservative Management of Esophageal Perforations During Pneumatic Dilation for Idiopathic Esophageal Achalasia
| Autor: | Dirk Vanbeckevoort, Willy Coosemans, Guy E. Boeckxstaens, Jan Tack, Kathleen Blondeau, Toni Lerut, Tim Vanuytsel |
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| Rok vydání: | 2012 |
| Předmět: |
Male
Nothing by mouth medicine.medical_specialty Pleural effusion medicine.medical_treatment Perforation (oil well) Achalasia Belgium Risk Factors medicine Humans Esophagus Adverse effect Aged Esophageal Perforation Hepatology business.industry Incidence Hazard ratio Age Factors Gastroenterology Odds ratio Middle Aged medicine.disease Dilatation Survival Analysis Anti-Bacterial Agents Surgery Esophageal Achalasia Treatment Outcome medicine.anatomical_structure Female business |
| Zdroj: | Clinical Gastroenterology and Hepatology. 10:142-149 |
| ISSN: | 1542-3565 |
| Popis: | 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.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.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). Age65 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%).Age65 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. |
| Databáze: | OpenAIRE |
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