Esophageal perforation post pneumatic dilatation for achalasia managed by esophageal stenting

Abstract

Patient: Female, 82Final Diagnosis: AchalasiaSymptoms: Nocturnal regurgtation • weight lossMedication: —Clinical Procedure: Esophageal stentingSpecialty: Gastroenterology • HepatologyObjective: Unusual or unexpected effect of treatmentBackground:Pneumatic dilatation is one of the most effective methods for treating achalasia. Esophageal perforation is the most serious complication after pneumatic dilatation and has been reported to occur in the range of 1 to 4.3%. The appropriate management of esophageal perforation can range from conservative medical treatment to surgical intervention.Case Report: We report a case of an 82-year-old male who had an 8 month history of dysphagia for solid and liquids, a 10 lb weight loss and nocturnal regurgitation. The diagnosis of achalasia was established by endoscopic; barium and manometric criteria. He underwent a pneumatic dilation with a 30 mm Rigiflex balloon. A confined or limited esophageal perforation projecting into the mediastinum and located 1–2 cm above the diaphragm was confirmed by a gastrografin swallow study performed immediately after the procedure. There was some accompanying epigastric abdominal pain. Patient was treated later that day by placing a fully covered metallic esophageal stent in addition to antibiotics, proton pump inhibitor, and fasting. Patient was discharged home 3 days later able to eat liquid-soft foods. Follow up endoscopy 2 weeks later and a gastrografin swallow showed a completely healed perforation and the stent was removed. Symptomatically he has done well, with no dysphagia or heartburn at six and twelve months follow up.Conclusions:Early esophageal stenting for esophageal perforation after pneumatic dilation for achalasia is a treatment option which accelerates healing shortens recovery period, as well as decreasing hospital stay and costs.

Successful Management of Esophageal Perforation with Self-Expandable Metal Stent following Pneumatic Dilation for Achalasia Cardia

“…Out of 11 patients in this series, only one had achalasia cardia. Another case report by Elhanafi et al 8 also described the similar use of SEMS for esophageal perforation following PD for achalasia cardia.…”

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

“…In search of less-invasive methods to close esophageal perforations, endoscopic techniques, such as over the scope clips and esophageal stenting, have been explored over the past years. However, these techniques also come with additional risks, while results are not overwhelming [4,6,7]. Stents may dislocate in the dilated esophagus of the achalasia patient or may not close off the wall at the proximal end.…”

“…Esophageal perforation is the most serious complication of pneumatic dilation for achalasia and is traditionally managed by conservative therapy or surgical repair [1][2][3]. With the introduction of new endoscopic techniques in the past decade, endoscopic management as primary therapy of iatrogenic perforation has been gaining ground [4][5][6][7]. We report four achalasia patients that underwent pneumatic dilatation complicated by an esophageal perforation.…”

A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation

“…However, due to the development of esophageal perforation, mediastinitis, and empyema on the 5 th day of hospitalization, decortication of the pleura, mediastinotomy for debridement and drainage, and chest tube placement were performed. The treatment strategy of this rare disease entity includes systemic antibiotic treatment to treat infection, prevention of progression of contamination, nutritional support, and preserving the continuity of the digestive tract, with timely surgical interventions if required [ 18 – 20 ].…”