Endoscopic stent placement for perforation after pneumatic dilation in achalasia.

Background and Aims: Esophageal perforation after pneumatic dilation for achalasia is a rare but life-threatening adverse event. We report a case of a large iatrogenic esophageal tear successfully managed with endoscopic stent placement. Methods: A 67-year-old man with achalasia underwent pneumatic balloon dilation under general anesthesia. A 5-cm distal esophageal tear was discovered on re-examination and was immediately treated with placement of a fully covered self-expandable metal stent, secured with an endoscopic suture. Supportive care included no oral intake, enteral feeding via a nasojejunal tube, and intravenous antibiotics. Results: The stent effectively sealed the perforation, and the patient remained stable with no signs of sepsis. No surgical intervention was required. The stent was removed after 2 weeks, with complete healing of the tear confirmed on follow-up endoscopy. Conclusions: Early endoscopic stent placement with secure fixation can successfully treat iatrogenic esophageal perforations after pneumatic dilation for achalasia. This case underscores the importance of prompt detection and closure of perforations and supports routine postdilation endoscopy to improve outcomes in high-risk cases.