title: Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature.
abstract: OBJECTIVE
  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 (P=0.02).
  
  
  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.
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
authors.forename: Kristle L
authors.initials: KL
authors.lastname: Lynch
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.forename: Colin W
authors.initials: CW
authors.lastname: Howden
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
mesh_terms: D000328:Adult; D000368:Aged; D004106:Dilatation / Q000009:adverse effects*; D004931:Esophageal Achalasia / Q000601:surgery / Q000628:therapy*; D004939:Esophageal Perforation / Q000453:epidemiology* / Q000209:etiology*; D004944:Esophagoplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013689:Telephone