title: Full-thickness esophageal perforation after fluoroscopic balloon dilation: incidence and management in 820 adult patients.
abstract: OBJECTIVE
  The purpose of this study is to investigate the incidence, management, and outcomes of esophageal perforation after fluoroscopic balloon dilation in 820 adult patients with esophageal diseases.
  
  
  METHODS
  Between December 1990 and April 2014, a total of 820 adult patients (age range, 21-93 years) underwent 1869 fluoroscopic balloon dilation sessions (mean, 2.3 sessions/patient; range, 1-29 sessions/patient) for esophageal diseases. We retrospectively reviewed the prospectively collected medical records and images of these patients and collected the data of patients who developed esophageal perforations after fluoroscopic balloon dilation.
  
  
  RESULTS
  During this period, 12 patients (six men and six women; mean age, 51 years; age range, 28-69 years) developed perforations. The perforation rate was 1.5% per patient and 0.6% per dilation. Among the first eight patients, four who were treated with surgery had perforations 2 cm or larger, and the other four who underwent fasting, parenteral alimentation, and treatment with antibiotics had perforations smaller than 2 cm. The last four patients underwent stent placement immediately after the diagnosis, regardless of the perforation's size. The median hospital stay was 11.5 days.
  
  
  CONCLUSIONS
  Fluoroscopic balloon dilation of esophageal diseases is a safe procedure with a low perforation rate. A perforation size greater than 2 cm is considered large and requires aggressive treatment. Although the number of patients with esophageal perforation we treated is relatively small and further clinical trials are needed, temporary stent placement seems to be an initial choice in the management of esophageal perforations after fluoroscopic balloon dilation.
authors.affiliation: 1 Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, Republic of Korea.
authors.forename: Wei-Zhong
authors.initials: WZ
authors.lastname: Zhou
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Song
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Young Chul
authors.initials: YC
authors.lastname: Cho
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Jun
authors.forename: Jihong
authors.initials: J
authors.lastname: Park
authors.forename: Soo Hwan
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004106:Dilatation / Q000379:methods*; D004935:Esophageal Diseases / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D004939:Esophageal Perforation / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: balloon dilation; esophageal perforation; esophageal stenosis