Complications and their impact after pneumatic dilation for achalasia: Prospective long-term follow-up study

Background: With the exception of esophageal perforations, complications of pneumatic dilation are incompletely defined. This study analyzes the incidence of all complications of this procedure and their impact on the patients' clinical course. Methods: Sixty-seven consecutive patients with achalasia underwent pneumatic dilation with a Browne-McHardy dilator. Patients were observed for 24 hours after treatment and evaluated 4 weeks later as well as at 2-year intervals for a mean follow-up period of 4.9 +/- 3.8 years. In patients with and without complications, the length of remission was evaluated by Kaplan-Meier life table analysis. Results: Twelve patients (18%) developed morphologic complications consisting in one perforation, two intramural hematomas, and nine diverticula at the gastric cardia. Ten patients (15%) complained of prolonged postdilation chest pain. The 5-year remission rate in the latter patients was 51% compared to 42% for patients without complications and 11% for patients developing traumatic diverticula. Surgery was ultimately performed in one third of all patients, a rate that remained unaffected by the type of complication. Conclusions: Complications of pneumatic dilation are underestimated and underreported. More than 30% of all patients develop either prolonged pain or morphologic lesions. Although prolonged pain does not indicate an unfavorable prognosis, the appearance of diverticula may be associated with a shorter clinical remission.