Major complications of pneumatic dilation and heller myotomy for Achalasia: Single-center experience and systematic review of the literature

Kristle L. Lynch, John E. Pandolfino, Colin Howden, Peter J. Kahrilas

Research output: Contribution to journalReview article

72 Citations (Scopus)

Abstract

Objectives: Pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) can be definitive therapies for achalasia; recent data suggest comparable efficacy. However, risk must also be considered. We reviewed the major complication rate of PD and LHM in a high-volume center and reviewed the corresponding literature.METHODS:We reviewed 12 years of our institution's achalasia treatment experience. During this interval, a consistent technique of PD was used utilizing Rigiflex dilators. Medical records were reviewed for post-procedure complications. We administered a telephone survey and examined medical records to assess efficacy of treatment. We also performed a systematic review of the literature for comparable clinical data and examined 80 reports encompassing 12,494 LHM and PD procedures.Results: At our center, 463 achalasia patients underwent 567 PD or LHM procedures. In all, 78% of the PDs used a 30-mm Rigiflex dilator. In all, 157/184 (85%) patients underwent 1 or 2 PD without any subsequent treatment. There were seven clinically significant perforations; one from PD and six from LHM. There were no resultant deaths from these perforations; two deaths occurred within 30 days of LHM from unrelated causes. Complications and deaths post-PD were significantly fewer than those post-LHM (P0.02).CONCLUSIONS:Esophageal perforation from PD at our high-volume center was less common than often reported and lower than that associated with LHM. We conclude that, in the hands of experienced operators using conservative technique, PD has fewer major complications and deaths than LHM.

Original languageEnglish (US)
Pages (from-to)1817-1825
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume107
Issue number12
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

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Esophageal Achalasia
Dilatation
Medical Records
Esophageal Perforation
Telephone
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Major complications of pneumatic dilation and heller myotomy for Achalasia : Single-center experience and systematic review of the literature. / Lynch, Kristle L.; Pandolfino, John E.; Howden, Colin; Kahrilas, Peter J.

In: American Journal of Gastroenterology, Vol. 107, No. 12, 01.12.2012, p. 1817-1825.

Research output: Contribution to journalReview article

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N2 - Objectives: Pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) can be definitive therapies for achalasia; recent data suggest comparable efficacy. However, risk must also be considered. We reviewed the major complication rate of PD and LHM in a high-volume center and reviewed the corresponding literature.METHODS:We reviewed 12 years of our institution's achalasia treatment experience. During this interval, a consistent technique of PD was used utilizing Rigiflex dilators. Medical records were reviewed for post-procedure complications. We administered a telephone survey and examined medical records to assess efficacy of treatment. We also performed a systematic review of the literature for comparable clinical data and examined 80 reports encompassing 12,494 LHM and PD procedures.Results: At our center, 463 achalasia patients underwent 567 PD or LHM procedures. In all, 78% of the PDs used a 30-mm Rigiflex dilator. In all, 157/184 (85%) patients underwent 1 or 2 PD without any subsequent treatment. There were seven clinically significant perforations; one from PD and six from LHM. There were no resultant deaths from these perforations; two deaths occurred within 30 days of LHM from unrelated causes. Complications and deaths post-PD were significantly fewer than those post-LHM (P0.02).CONCLUSIONS:Esophageal perforation from PD at our high-volume center was less common than often reported and lower than that associated with LHM. We conclude that, in the hands of experienced operators using conservative technique, PD has fewer major complications and deaths than LHM.

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