Over-the-Scope Clip Closure of Oesophageal Perforation after Pneumatic Dilatation for Achalasia

Pneumatic dilatation of the oesophagus is the first line method of therapy of achalasia. Pneumatic balloon dilatation induces forceful stretching of the lower oesophageal sphincter (LES), which weakens the LES by tearing its muscle fibers. Complications of Pneumatic balloon dilatation include oesophageal perforation in 1.6 % and heartburn in 45 %. Recently endoscopic approach has been introduced in treating gastrointestinal perforations which is less invasive than surgery and have the advantages of lesser morbidity and mortality, shorter hospital stay, and shorter periods of avoiding oral feeding. The main endoscopic methods used to close GI perforations are endoclips and covered self-expandable stents the margins. We report the case of a 51 year-old female patient presenting with oesophageal tear after pneumatic dilatation for achalasia. Over-the-scope clip (OTSC) was used for the Closure of the oesophageal tear. To the best of our knowledge this is the first case report of successful closure of oesophageal tear secondary to post pneumatic dilation of the oesophagus for the treatment of Achalasia using the OTSC.