Risk factors for immediate complications after progressive pneumatic dilation for achalasia

OBJECTIVE: The aim of this retrospective study was to determine the risk fa ctors of early complications after progressive pneumatic dilation for achal asia. METHODS: Five hundred four dilations were performed in 237 consecutive acha lasic patients between 1980 and 1994 with the same technique: low-pressure pneumatic dilation every other day with balloons of increasing diameter unt il success criteria were obtained (depending on manometric examination and esophageal x-ray transit performed 24 h after each dilation). Clinical, rad iographical, endoscopical, and manometrical data as technical procedure cha racteristics for patients with perforations or other early complications we re compared with those without complications. RESULTS: We observed 15 complications (6% of patients): 7 perforations (3%) , 3 asymptomatic esophageal mucosal tears, 4 esophageal hematomas, and 1 fe ver. Perforations occurred in 6 of 7 patients during the first dilation. Th e mean age was 68.5 yr in the group with complications versus 56.4 yr for t he remainder (p < 0.05). Two deaths occurred in patients older than 90 yr. Instability of the balloon during dilations was noted in 8 of 15 cases of c omplications versus 57 of 222 patients (p < 0.05). No other data differed s ignificantly. CONCLUSIONS: This study showed a low prevalence of early complications usin g this progressive technique. Patients with hiatal hernia, esophageal diver ticulum, or vigorous achalasia may safely undergo progressive pneumatic dil ation. Only patients older than 90 yr should be referred for progressive pn eumatic dilation with caution. Most of perforations arose during the first dilation, but there was no predictive pretherapeutic factor of perforation. (C) 1999 by Am. Coil. of Gastroenterology.