{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:53:58Z","timestamp":1783418038221,"version":"3.54.6"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1996,7]]},"abstract":"<jats:p>BACKGROUND\/AIMS: Pneumatic dilatation of the oesophagus is a well established treatment for achalasia. Oesophageal perforation is the most serious complication that occurs in 2% to 6% of cases. The aim of this retrospective survey was to identify predictive risk factors for perforation in a consecutive series of 218 patients with achalasia. METHODS: Between 1983 and 1993, 270 pneumatic dilatations were performed in 218 patients. A Witzel dilator was used in 58 cases and a Rigiflex dilator in 212. Eight oesophageal perforations occurred (3%). The clinical, radiological, endoscopic, manometric, and technical data for the eight perforated patients were compared with those of 30 patients randomly sampled among those without perforation. RESULTS: All perforations occurred during the first dilatation. Perforations were fewer during dilatations with the Rigiflex dilator than with the Witzel dilator (2.4% v 5.2%). Perforations were all located above the cardia, on the left side of the oesophagus. In a multivariate analysis, a small weight loss and a high amplitude of oesophageal contractions in the group of patients with perforations were predictive of complications (respectively, p = 0.001 and p = 0.026). A contraction amplitude higher than 70 cm H2O in the lower part of the oesophagus was observed in three of eight patients with perforations but was not seen in any of the 30 patients without perforation (p &lt; 0.01). CONCLUSIONS: This identification of risk factors should facilitate the choice between pneumatic dilatation or a surgical approach.<\/jats:p>","DOI":"10.1136\/gut.39.1.9","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"9-12","source":"Crossref","is-referenced-by-count":76,"title":["Risk factors of oesophageal perforation during pneumatic dilatation for achalasia."],"prefix":"10.1136","volume":"39","author":[{"given":"E","family":"Borotto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Gaudric","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Danel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Samama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Quartier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Chaussade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Couturier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1996,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S0889-8553(21)00676-2","volume":"18","author":"Reynolds, J.C.; Achalasia, Parkman H.P.","year":"1989","unstructured":"Reynolds JC, Parkman HP. Achalasia. Gastroenterol Clin North Am 1989; 18: 223-55.","journal-title":"Gastroenterol Clin North Am"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/BF01296115","article-title":"Complications during pneumatic dilatation for achalasia or diffuse esophageal spasm. Analysis of risk factors, early clinical characteristics, and outcome","volume":"38","author":"Nair, L.A.; Reynolds, J.C.; Parkman, H.P.; Ouyang, A.; Strom, B.L.; Rosato, E.F.","year":"1993","unstructured":"Nair LA, Reynolds JC, Parkman HP, Ouyang A, Strom BL, Rosato EF, et al. Complications during pneumatic dilatation for achalasia or diffuse esophageal spasm. 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Gastrointest Endosc 1981; 27: 229-34.","journal-title":"Gastrointest Endosc"},{"key":"ref_5","first-page":"774","article-title":"Intrasphincteric botulinum toxin for the treatment of achalasia","volume":"322","author":"Pasricha, P.J.; Ravich, W.J.; Hendrix, T.R.; Sostre, S.; Jones, B.; Kalloo, N.","year":"1995","unstructured":"Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo N. Intrasphincteric botulinum toxin for the treatment of achalasia. NEnglJMed 1995; 322: 774-8.","journal-title":"NEnglJMed"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1001\/archinte.1976.03630050053010","article-title":"Achalasia and diffuse esophageal spasm","volume":"136","author":"Castell, D.O.","year":"1976","unstructured":"Castell DO. Achalasia and diffuse esophageal spasm. Arch Intern Med 1976; 136: 571-9.","journal-title":"Arch Intern Med"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1055\/s-2007-1021677","article-title":"Treatment of achalasia with a pneumatic dilator attached to a gastroscope","volume":"13","author":"Witzel, L.","year":"1981","unstructured":"Witzel L. Treatment of achalasia with a pneumatic dilator attached to a gastroscope. Endoscopy 1981; 13: 176-7.","journal-title":"Endoscopy"},{"key":"ref_8","first-page":"1502","article-title":"Balloon dilation in achalasia","volume-title":"A promising technique. Gastroenterology 1986; 90","author":"Kozarek, R.A.; Gelfand, M.D.; Christie, D.L.; Ball, T.J.","unstructured":"Kozarek RA, Gelfand MD, Christie DL, Ball TJ. Balloon dilation in achalasia. A promising technique. Gastroenterology 1986; 90: 1502."},{"key":"ref_9","first-page":"458","article-title":"Esophageal perforation due to pneumatic dilation for achalasia","volume":"166","author":"Miller, E.R.; Tiskenkel, H.I.","year":"1988","unstructured":"Miller ER, Tiskenkel HI. Esophageal perforation due to pneumatic dilation for achalasia. Surg Gynecol Obstet 1988; 166: 458-60.","journal-title":"Surg Gynecol Obstet"},{"key":"ref_10","first-page":"14454","article-title":"Treatment of achalasia and related motor disorders","volume":"79","author":"Vantrappen, G.; Hellemans, J.","year":"1980","unstructured":"Vantrappen G, Hellemans J. Treatment of achalasia and related motor disorders. Gastroenterology 1980; 79: 14454.","journal-title":"Gastroenterology"},{"key":"ref_11","first-page":"893","article-title":"Gastric perforation during pneumatic dilation for achalasia","volume":"72","author":"Brown, F.C.; Johnson, R.B.; Castell, D.O.","year":"1977","unstructured":"Brown FC, Johnson RB, Castell DO. Gastric perforation during pneumatic dilation for achalasia. Gastroenterology 1977; 72: 893-8.","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1055\/s-2007-1012793","article-title":"The danger of high compliance balloons for esophageal dilatation in achalasia","volume":"22","author":"Rabinovici, R.; Katz, E.; Goldin, E.; Kluger, Y.; Ayalon, A.","year":"1990","unstructured":"Rabinovici R, Katz E, Goldin E, Kluger Y, Ayalon A. The danger of high compliance balloons for esophageal dilatation in achalasia. Endoscopy 1990; 22: 63-4.","journal-title":"Endoscopy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/BF01072193","article-title":"Manometric asymetry of the lower esophageal high pressure zone","volume":"22","author":"Winans, C.S.","year":"1977","unstructured":"Winans CS. Manometric asymetry of the lower esophageal high pressure zone. 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BrJSurg 1967; 54: 286-92.","journal-title":"BrJSurg"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/0002-9343(89)90385-9","article-title":"Boerhave revisited: spontaneous esophageal perforation as a diagnostic masquerader (reviews)","volume":"86","author":"Henderson, J.A.M.; Peloquin, A.J.M.","year":"1989","unstructured":"Henderson JAM, Peloquin AJM. Boerhave revisited: spontaneous esophageal perforation as a diagnostic masquerader (reviews). Am Jf Med 1989; 86: 559-67.","journal-title":"Am Jf Med"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/0016-5085(95)23409-8","article-title":"Botulinum toxin for achalasia: long term follow up and predictors of outcome","volume":"108","author":"Pasricha, P.J.; Rai, R.; Ravich, W.J.; Hendrix, T.R.; Kalloo, N.","year":"1995","unstructured":"Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo N. Botulinum toxin for achalasia: long term follow up and predictors of outcome. 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Gastroenterology 1995; 108: A123."}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.39.1.9","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T05:37:26Z","timestamp":1757309846000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.39.1.9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,7]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[1996,7,1]]},"published-print":{"date-parts":[[1996,7]]}},"alternative-id":["10.1136\/gut.39.1.9"],"URL":"https:\/\/doi.org\/10.1136\/gut.39.1.9","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1996,7]]}}}