Role of Endoscopy in the Management of Boerhaave Syndrome

Tellechea, Juan Ignacio; Gonzalez, Jean‐Michel; Miranda-García, Pablo; Culetto, Adrian; D’Journo, Xavier Benoît; Thomas, Philippe; Barthet, Marc

doi:10.5946/ce.2017.043

Cited by 26 publications

(24 citation statements)

References 11 publications

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“…In patients with late presentation and in patients with non-endoscopic EP, the use of endoscopy as first-line therapy may be considered (Grade 2C). Although successful endoscopic management has been reported in select Boerhaave [89–91] patients with minimal symptoms and signs of sepsis, concerns on patient safety warrant caution regarding first-line use of endoscopic treatment under such circumstances [71, 89]. Endoscopic stenting is a useful adjunct treatment tool in patients with persistent leakage following surgical treatment of EP [92].…”

Section: Methodsmentioning

confidence: 99%

Esophageal emergencies: WSES guidelines

et al. 2019

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The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.

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Section: Methodsmentioning

confidence: 99%

Esophageal emergencies: WSES guidelines

et al. 2019

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“…Which is the best way to approach BS is still a matter of debate: actual guidelines for thoracic esophageal perforation suggest an individualized approach to primary repair the tear, while for what concern specifically esophageal spontaneous rupture, most of the available studies considered the thoracotomy/thoracoscopic approach as the way of choice [9,[17][18][19][20][21]. Anyway, there is not any specific guidelines for BS: some case reports suggest that laparoscopy may be just as safe and effective [12,13]; lastly, some authors also reported conservative or endoscopic treatment: nevertheless, these are just a few studies involving patients with less severe clinical picture, so further researches are needed to better understand their feasibility in more challenging conditions [5,7]. In this case series, we present our 5 years' experience: in all patients, we choose to approach laparoscopically the esophageal tear; when necessary, afterwards we performed a thoracic lavage through left thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the aim of the treatment should be both repair the esophageal tear and control the mediastinal contamination: on these bases, different strategies have been proposed. The most diffuse approach is the surgical direct repair with placement of a thoracic drainage: recently, less invasive approaches have been suggested such as conservative and endoscopic treatments, but there are only a few case series reporting discouraging or inconstant results [5][6][7]; thus, at the moment, surgery remains the cornerstone of BS management.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave’s syndrome: an Italian single center case series study

et al. 2020

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Background: Boerhaave's syndrome (BS) is a rare life-threating condition with poor prognosis. Unfortunately, due to its very low incidence, no clear evidences or definitive guidelines are currently available: in detail, surgical strategy is still a matter of debate. Most of the case series reports thoracic approach as the most widely used; conversely, transhiatal abdominal management is just described in sporadic case reports. In our center, the laparoscopic approach has been adopted for years: in the present study, we aim to show his feasibility by reporting the outcomes of the largest clinical series available to date. Methods: Clinical records of patients admitted for BS to the General and Upper GI Surgery Division of Verona from February 2014 to December 2019 were retrospectively collected. Clinico-pathological characteristics, preoperative workup, surgical management, and outcomes were analyzed. Results: Seven patients were admitted; epigastric/thoracic pain and vomiting were the most frequent symptoms at diagnosis. Laboratory findings were not specific; conversely, radiological imaging always revealed abnormal findings: particularly, CT had excellent sensitivity in detecting signs of esophageal perforation. All but one case had diagnostic workup and received surgery within 24 h. Every patient had laparoscopic transhiatal direct suture and gastric valve; 2 patients (28.6%) also needed a thoracoscopic toilette. Postoperative complications occurred in 4 patients (57%), but in only two of them (29%), the complication was severe according to Clavien-Dindo classification (both received thoracentesis or thoracic drainage for pleural effusion). Of note, no cases of postoperative esophageal leak were recorded. Postoperative mortality was 14% due to one patient who died for cardiovascular complications. Most of the patients (71.4%) were admitted to ICU after surgery (average length, 8.8 days); mean hospital stay was 14.7 days. No patients had readmissions.

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“…11 Ongoing debates exist regarding best practices based on a patient's presenting clinical scenario, with the current literature suggesting that endoscopic therapy be reserved for early presenters, those with a defect less than 1 cm and without evidence of sepsis, thus indicating a promising role for endoscopy in a carefully selected population with Boerhaave syndrome. 15,16…”

Section: Discussionmentioning

confidence: 99%

Boerhaave Syndrome Causing Bilateral Empyemas

et al. 2019

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Boerhaave syndrome is a perforation of the esophagus caused by a sudden increase in intraluminal pressure. It is known to be associated with left-sided pleural effusion and mediastinitis, but rarely presents with bilateral effusion. Its association with the presence of a hiatal hernia is unclear. We present a patient with a hiatal hernia who developed bilateral empyemas because of Boerhaave syndrome and was treated with an endoscopically placed esophageal stent.

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Role of Endoscopy in the Management of Boerhaave Syndrome

Abstract: Cases and Techniques Library (CTL) E24Musala Carmen et al. Boerhaave syndrome treatment with an over-the-scope clip … Endoscopy 2015; 47: E24-E25

Cited by 26 publications

References 11 publications

Esophageal emergencies: WSES guidelines

Esophageal emergencies: WSES guidelines

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave’s syndrome: an Italian single center case series study

Boerhaave Syndrome Causing Bilateral Empyemas

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