BCM
Gastroenterology Grand Rounds - Take Home Lessons
The main lessons to take home concerning this case
are:
1. Surgery and Pneumatic dilation offer similar advantages
in the initial management of Esophageal Achalasia, but dilation may be
more cost-effective.
2. Symptomatic esophageal perforation in the setting
of dilation is best managed with surgery within 10-12 hours. The role of
conservative management of small perforations is still debated.
3. Radiographic evaluation immediately after dilation
does not predict clinical response, and its role in the asymptomatic post-dilation
patient is not clear.
4. There are no clinically useful pre-dilation factors
which reliably predict risk of perforation with PD for achalasia.
