Short-Term Esophageal Stenting in the Management of Benign Perforations

Heel, Nicoline C.M. van; Haringsma, Jelle; Spaander, Manon; Bruno, M. J.; Kuipers, Ernst J.

doi:10.1038/ajg.2010.104

Cited by 130 publications

(81 citation statements)

References 37 publications

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“…In 2009, Leers et al reported a series of 15 patients treated with self-expanding metal stents, achieving a success rate of 87% without further intervention (23). Van Heel and colleagues also reported a series of 33 patients with an esophageal perforation treated with a variety of stent types in 2010 (24). Despite the stent sealing the perforation in 32 (97%) patients, 4 (12%) patients eventually required esophagectomy because of a recurrent leak or complications of removing the stent.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents.Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse J Thorac Dis 2017;9(Suppl 2):S135-S145 jtd.amegroups.com significantly less esophageal dilatation, a lower rate of migration and improved palliation for malignant esophageal strictures and malignant tracheo-esophageal fistulae (10,11). However, placement of these prostheses continued to be reserved only for the patient requiring palliative therapy for a malignancy because of the potential esophageal damage associated with extraction including reports of irreparable, sometimes life threatening, fistulae.To combat these complications, second generation metallic stent designs were developed incorporating a covering of silicone, polyurethane or other polymers (12). While offering the advantage of diminishing amount of tumor ingrowth and fixation to the esophageal wall, it came with the cost of higher migration rates. Later, the ends of these covered stents were modified to be partially covered with a margin of 1.5 cm on both proximal and distal ends to optimize purchase of the esophageal wall (13).Further evolution in esophageal stent biomaterials resulted in the development of an occlusive plastic prosthesis coated with silicone. This new design allowed ease of insertion, a minimal requirement for esophageal dilation and the ability to form an occlusive seal within the lumen of the esophagus (14). The distinctive advantage of these non-metallic endoprostheses was the ability for removal or replacement even after an extended period of time without damage to the esophagus. However, similar to the covered metallic stents, a higher incidence of migration was appreciated (15).These synergistic developments led to a crucial turning point in management of esophageal perforations. The ease in manipulation of high-quality covered, occlusive stents in the esophagus, led some investigators to implant these stents in select patients as a temporary measure to treat intrathoracic anastomotic leaks following esophagogastrostomy and acute perforations. Segalin et al. and Roy-Choudhury et al. were am...

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Section: Introductionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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“…Corresponding to the literature, the etiology of esophagus perforation was mainly iatrogenic in our database [6]. Factors increasing the risk of iatrogenic perforation include preexisting diseases such as large hiatal hernia, vigorous achalasia, or…”

Section: Discussionmentioning

confidence: 85%

“…Treatment options include operative and nonoperative managements such as stent implantation [9,10]. The best indication of stent implantations is small perforations diagnosed early without any signs of sepsis that have an adequate distance to the upper and lower esophageal sphincters for a sufficient sealing [6]. Stent explantation is recommended after 4-6 weeks [6,11].…”

Section: Early Presentation <24hmentioning

confidence: 99%

“…The best indication of stent implantations is small perforations diagnosed early without any signs of sepsis that have an adequate distance to the upper and lower esophageal sphincters for a sufficient sealing [6]. Stent explantation is recommended after 4-6 weeks [6,11]. A nonoperative treatment in presence of free fluid, contrast extravasation, or mediastinitis on computed tomography is associated with failure and high mortality [12].…”

Section: Early Presentation <24hmentioning

confidence: 99%

“…Based on our experience and based on available literature [6,9,11,12,16], we created a treatment algorithm for our hospital (Fig. 1).…”

Section: Early Presentation <24hmentioning

confidence: 99%

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Treatment of Early and Delayed Esophageal Perforation

et al. 2012

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Esophageal perforations are life threatening emergencies associated with high morbidity and mortality. We report on 22 consecutive patients (age 20-86; 13 female and 9 male) with an oesophageal perforation treated at the university hospital Duesseldorf. The patients' charts were reviewed and follow-up was completed for all patients until demission, healed reconstruction or death. Patients' history, clinical presentation, time interval to surgical presentation, and treatment modality were recorded and correlated with patients' outcome. Six esophageal perforations were due to a Boerhaave-syndrome, eleven caused by endoscopic perforation, two after osteosynthesis of the cervical spine and three foreign body induced. In 7 patients a primary local suture was performed, in 4 cases a supplemental muscle flap was interposed, and 7 patients underwent an oesophageal resection. Four patients were treated without surgery (three esophageal stent implantations, one conservative treatment). Eleven patients (50 %) were presented within 24 h of perforation, and 11 patients (50 %) afterwards. Time delay correlates with survival. In 17 (80.9 %) cases a surgical sufficient reconstruction could be achieved. One (4.7 %) patient is waiting for reconstruction after esophagectomy. Four (18.2 %) patients died. A small subset of patients can be treated conservatively by stenting of the Esophagus, if the patient presents early. In the majority of patients a primary repair (muscle flap etc.) can be performed with good prognosis. If the patient presents delayed with extensive necrosis or mediastinitis, oesophagectomy and secondary repair is the only treatment option with high mortality.

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Foreign body impaction in the esophagus

Triadafilopoulos

2015

Gastrointestinal Emergencies

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Short-Term Esophageal Stenting in the Management of Benign Perforations

Cited by 130 publications

References 37 publications

Endoscopic management of esophageal leaks

Endoscopic management of esophageal leaks

Treatment of Early and Delayed Esophageal Perforation

Foreign body impaction in the esophagus

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