Management of Esophageal Perforation

Ökten, İlker; Cangır, Ayten; Özdemır, Nezıh; Kavukçu, Şevket; Akay, Hadı; Yavuzer, Sema

doi:10.1007/s005950170217

Cited by 99 publications

(73 citation statements)

References 16 publications

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“…1 Despite improvement in diagnostic procedures and (surgical) interventions, ruptures and leaks in the oesophagus are still potentially life-threatening injuries associated with a high morbidity and mortality if treated surgically. [2][3][4][5][6][7][8] Surgical treatment has long been the 'gold standard' for these emergencies. 1,5,[9][10][11][12] Over the past few years, new minimally invasive endoscopic treatment options have emerged, i.e.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

263

232

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Summary Background Placement of self‐expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs. Methods A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Results Twenty‐five studies, including 267 patients with complete follow‐up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent‐related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in‐ and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68]. Conclusions Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6–8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self‐expanding plastic stents and fully covered self‐expanding metal stents) and, to a minor degree, on expected risk of tissue in‐ or overgrowth (partially covered self‐expanding metal stents).

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Section: Discussionmentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

263

232

View full text Add to dashboard Cite

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“…Perforation depends on increased intra-esophageal pressure, while the upper sphincter is closed during excessive vomiting [1,2]. In the case which is presented here, a spontaneous esophageal perforation occurred due to increased intra-esophageal pressure caused an esophageal stricture, instead of upper esophageal sphincter.…”

Section: Introductionmentioning

confidence: 96%

“…Meyer reported death due to the disease in 1852, and successful treatment was reported after 1947 [2,3]. 80% BS cases is seen in males especially between age 40 and 60 years.…”

Section: Case Reportmentioning

confidence: 99%

“…Ökten et al reported a mortality rate of 45.5% with conservative treatment and 20% with surgical treatment [2]. Schmidt et al reported hospital mortalities of 11.1% within 6 hours, 13.3% within 6-24 hours, and 22.2% for repairs performed after 24 hours in their 62 case series [3].…”

Section: Case Reportmentioning

confidence: 99%

“…Mortality ranges varies from 28%-85% between series [2][3][4]8]. Ökten et al reported a mortality rate of 45.5% with conservative treatment and 20% with surgical treatment [2].…”

Section: Case Reportmentioning

confidence: 99%

See 2 more Smart Citations

Esophageal Stenosis as a Cause of Spontaneous Esophageal Perforation (Boerhaave Syndrome): A Case Report and Explanation of Possible Mechanism

Öz¹,

Kargi²

2016

J Trauma Treat

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Management of Iatrogenic Cervical Esophageal Perforations

Chen

Shapira‐Galitz

Garber

et al. 2020

JAMA Otolaryngol Head Neck Surg

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sophageal perforation is a rare but life-threatening condition that is difficult to diagnose and treat, with an incidence of 3.1 cases per 1 000 000 per year. 1 It has an overall mortality rate of 13.3%, but this percentage varies from 4% to 80% depending on the type of perforation and the time to diagnosis. 2 Discrepancies in the diagnosis and management of esophageal perforations also contribute to the wide range of mortality rates. The most common causes of esophageal perforation are iatrogenic (46.5%), spontaneous (37.8%), foreign body (6.3%), corrosive (1.8%), and traumatic (<1%). 2,3 Overall, 72.6% of esophageal perforations are thoracic, 15.2% are cervical, and 12.5% are abdominal. 2 Cervical esophageal perforations (CEPs) have a mortality rate of 6% to 8%, [4][5][6][7] which is the lowest mortality rate for esophageal perforations. However, there is little existing literature that focuses specifically on cervical perforations. A 10-year cross-sectional study 4 of CEPs found them to be due to iatrogenic injury (58%), foreign body ingestion (27%), and penetrating injury (15%). Iatrogenic CEPs (iCEPs) are unique among CEPs for various reasons. The increased frequency of endoscopy for diagnosis and treatment has led to a rising number of iatrogenic esophageal injuries. 8 In addition, the management of iCEPs is controversial and lacking in evidence. Conservative management includes antibiotics and feeding tube placement, but cervical drainage is also frequently added to this treatment regimen. More aggressive surgical approaches to treatment, such as pri-

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Management of Esophageal Perforation

Cited by 99 publications

References 16 publications

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Esophageal Stenosis as a Cause of Spontaneous Esophageal Perforation (Boerhaave Syndrome): A Case Report and Explanation of Possible Mechanism

Management of Iatrogenic Cervical Esophageal Perforations

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