American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a complication of endoscopic pneumatic dilation used to treat achalasia?

1. Infection

2. Perforation

3. Increased reflux

4. Gastric bleeding

The correct answer is: Perforation

Endoscopic pneumatic dilation is a procedure commonly used to treat achalasia, which is a condition that affects the ability of the esophagus to move food into the stomach due to dysfunction of the lower esophageal sphincter. One of the potential complications associated with this procedure is perforation of the esophagus. Perforation can occur when the balloon used during the dilation exerts too much pressure, leading to a tear in the esophageal wall. This is a serious complication and can result in significant morbidity. It may necessitate surgical intervention and can also lead to complications such as mediastinitis (inflammation of the tissue in the middle of the chest) or sepsis due to leakage of esophageal contents into the thoracic cavity. In contrast, while infection, increased reflux, and gastric bleeding can occur with various medical procedures or conditions, they are not the most direct complications associated specifically with endoscopic pneumatic dilation for achalasia. Infection is more of a general risk associated with any invasive procedure. Increased reflux may occur in the long term after dilation, but it is not an acute complication like perforation. Gastric bleeding is not a common complication of this specific procedure, focusing instead on the esophagus rather than the stomach. Thus, perfor