Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium.
Clin Gastroenterol Hepatol. 2012 Feb;10(2):142-9. doi: 10.1016/j.cgh.2011.10.032. Epub 2011 Nov 7.
BACKGROUND & AIMS: 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). Age >65 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%).
Age >65 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.
食管穿孔是贲门失弛缓症患者行气囊扩张术（PD）后最严重的不良事件，通常需要手术修复。我们旨在研究 PD 后发生食管穿孔的危险因素，并评估非手术治疗策略的安全性和长期效果。
我们分析了 1992 年至 2010 年在比利时鲁汶大学医院接受 PD 治疗的贲门失弛缓症患者的病历资料；所有食管穿孔患者均被联系以确定长期结果。使用 Vantrappen 标准评估贲门失弛缓症的结果。
在 372 例经测压证实的贲门失弛缓症患者（57±1 岁，51%为男性）中，830 次 PD 操作中有 16 次（1.9%的扩张）并发穿壁性食管穿孔。年龄>65 岁是唯一与并发症显著相关的危险因素（比值比，3.5；95%置信区间，1.2-10.2）。所有患者均采用广谱抗生素和禁食进行保守治疗。6 例（38%）患者的病程进一步并发胸腔积液，其中 4 例需要引流。1 例（6%）患者在 PD 后 12 小时内死于纵隔血肿。有并发症的患者在 19±2.3 天后出院，而无并发症的患者在 4±0.2 天后出院（P<0.0001）。对 12 例（75%）患者进行了长期结果（平均随访 84±14 个月）的测定，11 例（69%）患者的结果为优或良，1 例（6%）为中度。
年龄>65 岁是 PD 后发生食管穿孔的显著危险因素。非手术治疗穿壁性食管撕裂是可行的，具有良好的短期和长期效果，但并非没有并发症。
