CONSERVATIVE MANAGEMENT OF ESOPHAGEAL NONTRANSMURAL TEARS AFTER PNEUMATIC DILATION FOR ACHALASIA

Objective: We sought to determine the incidence and outcome with conse rvative management of esophageal nontransmural tears after pneumatic d ilation for achalasia. Methods: Retrospective review of 50 pneumatic b alloon dilations in 30 patients with achalasia was performed at one ce nter over an 18-month period. Results: Forty-four of 50 procedures (88 %) were performed without complication. Two patients (4%) developed tr ansmural perforations requiring immediate surgical repair; both recove red uneventfully. Four patients (8%) were found to have linear mucosal tears on routine postprocedure esophagrams. One patient was asymptoma tic, and three had chest pain. No patient had fever. These four patien ts were managed conservatively with in-hospital observation for a mean of 4.3 days (range 3-6): nothing by mouth for a mean of 1.3 days (ran ge 1-2) and i.v. antibiotics for a mean of 3 days (range 2-5). All wer e discharged within 6 days and were asymptomatic and tolerating a regu lar diet. Conclusions: Esophageal nontransmural tears are not uncommon after pneumatic dilation for achalasia and can be safely treated with conservative medical management.