Achalasia. Short-term clinical monitoring after pneumatic dilation.

Although concern about perforation has led physicians to perform pneumatic dilation for achalasia with routine contrast radiography immediately afterwards and with hospitalization, the need for these precautions has not been demonstrated. In contrast, we have routinely performed pneumatic dilations without contrast studies or hospitalization, and we hereby present our experience. During a recent six-year period, 110 pneumatic dilations were performed, and 71 of the last 73 were performed as outpatients with about 5-8 hr of clinical monitoring. Detailed review of 100 records showed that only 15 patients underwent contrast studies because of pain or fever. Perforation occurred in seven of the 15 patients, all of whom underwent surgery successfully. Short-term follow-up in patients who did not sustain perforation showed good or excellent results in 82%. Thus, it has been our experience that pneumatic dilation could be safely performed in achalasia without routine use of contrast studies or hospitalization.