Oesophageal tears during pneumatic balloon dilatation for the treatment of achalasia.

Fifty-eight contrast studies of the oesophagus, performed in patients shortly after balloon dilatation for the treatment of achalasia, were reviewed for evidence of perforation. Forty-nine examinations (85%) were normal and nine studies (15%) were abnormal. Three main radiological patterns were observed. Complete rupture of the oesophagus occurred in two cases. Incomplete tears of the oesophageal wall were present in seven cases: in one patient there was a linear mucosal tear while in six patients there was a localised outpouch or diverticulum. All patients with abnormal contrast studies were successfully managed conservatively. The range of radiological appearances of the distal oesophagus following balloon dilatation should be recognised to avoid unnecessary surgical intervention.