Treatment of endoscopic esophageal perforation

Fernández, Francisco Fernández; Richter, Α.; Freudenberg, S.; Wendl, K.; Manegold, B. C.

doi:10.1007/s004649901147

Cited by 84 publications

(62 citation statements)

References 20 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

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“…The clinical course of EP essentially depends on the location and the extent of the injury as well as the time elapsing between the perforation and the start of the treatment [2]. Primary surgical repair is the treatment of choice in early diagnosed EP.…”

Section: Introductionmentioning

confidence: 99%

The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Bayram

Erol

Melek

et al. 2015

EAJM

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Objective: Esophageal perforation (EP) is a critical and potentially life-threatening condition with considerable rates of morbidity and mortality. Despite many advances in thoracic surgery, the management of patients with EP is still controversial. Materials and Methods:We retrospectively reviewed 34 patients treated for EP, 62% male, mean age 53.9 years. Sixty-two percent of the EPs were iatrogenic. Spontaneous and traumatic EP rates were 26% and 6%, respectively. Three patients had EP in the cervical esophagus and 31 in the thoracic esophagus.Results: Mean time to initial treatment was 34.2 hours. Twenty patients comprised the early group <24 h) and 14 patients the late group (>24 h). Management of the EP included primary closure in 30 patients, non-surgical treatment in two, stent in one and resection in one. Mortality occurred in nine of the 34 patients (26%). Mortality was EP-related in four patients. Three of the nine patients that died were in the early group (p<0.05). Mean hospital stay was 13.4 days. Conclusion:EP remains a potentially fatal condition and requires early diagnosis and accurate treatment to prevent the morbidity and mortality. Keywords: Esophageal perforation, emergency treatment, thoracic surgery ÖzetAmaç: Özofagus perforasyonları (ÖP) kritik , hayatı tehdit eden mortalite ve morbidite riski yüksek olgulardır. Göğüs Cerrahisi'ndeki tüm gelişmelere rağmen bu olgulara yaklaşım günümüzde de tartışmalıdır. Gereç ve Yöntem:ÖP nedeniyle tedavi ettiğimiz 34 hastayı retrospektif olarak değerlendirdik. Erkek hastalar tüm hastaların %62' sini oluşturmaktaydı. Ortalama yaş: 53,9 olarak saptandı. Tüm perforasyonların %62' si iatrojenik nedenlerden kaynaklanmaktaydı. Spontan ve travmatik perforasyon oranları sırasıyla %26 ve % 6 olarak hesaplandı. 3 Hastada boyunda, 31 hastada ise torasik özofagusda perforasyon saptandı. Bulgular:Tedavinin ortalama başlama süresi 34, 2 saatti. 20 hasta erken grup içindeydi (<24 saat), 14 hasta ise geç grup (>24 saat) olarak sınıflandırıldı. Cerrahi olarak; 30 hastada primer onarım,1 hastada özofagus rezeksiyon ve anastamoz, 1 hastada stent ve 2 hastada medikal tedavi uygulandı. Mortalite 9 hastada gelişti %26. Mortalite nedeni 4 hastada ÖP'a sekonderdi. 9 Hastanın 3' ü erken tedavi grubundaydı (p<0,05). Ortalama hastanede yatış süresi 13,4 gündü. Sonuç: ÖP potansiyel ölümcül sonuçlar doğurabileceğinden morbidite ve mortaliteyi azaltmak için erken tanı ve etkili tedavi gereklidir. Anahtar Kelimeler: Özofagus perforasyonu, acil tedavi, göğüs cerrahisiCorrespondence to: M. Muharrem Erol,

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“…The outlook on treatment of anastomosis dehiscence in the thorax is controversial in the literature; therapy is modified individually according to the size of the fistula and overall patient condition. Especially in cases of small dehiscence, in some publications, endoscopic therapy is preferred using tissue glue, endoclips and stents 18,16 . Schubert et al report the successful treatment of 25/27 patients with dehiscence in anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Esophagectomy for esophageal carcinoma - surgical complications and treatment

Vrba¹,

Aujeský²,

Hrabalová³

et al. 2012

BIOMED PAP

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Aim. To describe our experience with esophagectomy for esophageal cancer and, the development and treatment of complications arising from the surgery. Material and methods. From 2007 to 8/2010, esophagectomy for esophageal carcinoma was performed in 75 patients at the 1 st Surgical Clinic. Primary esophagectomy was indicated in 20 patients with T1N0 stage or in cases where neoadjuvant treatment was contraindicated. 55 patients with T2,3N0,1 stages received neoadjuvant radiochemotherapy. Esophagectomy was performed via an abdominal approach (transhiatal laparoscopy in 44 patients, laparotomy in 3 patients) and a thoracic approach (thoracoscopy in 10 patients, thoracotomy in 18 patients).Results. In 18 cases, one or both pleural cavities were opened by means of dissection of the mediastinal pleura during the transhiatal laparoscopic esophagectomy. The morbidity was 26.6% and the following complications were encountered: pulmonary (15 patients), anastomosis dehiscence (5), postoperative bleeding in the mediastinum (1), fistula between trachea and transposition (1), paresis of the left recurrent nerve (8), infectious complications in the abdominal cavity (2), thoracic cavity (1), and early complications (2). The sixty-day mortality was 8% and this was mostly due to pulmonary complications (4 patients) but included coronary thrombosis (1) and transposition necrosis (1). Conclusion. The dominating complications of esophagectomy were pulmonary (20 %). The remaining serious complications cannot be completely eliminated but if diagnosed in time and treated in a correct algorithm they do not have to imminently threaten the lives of patients.

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Treatment of endoscopic esophageal perforation

Cited by 84 publications

References 20 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

The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Esophagectomy for esophageal carcinoma - surgical complications and treatment

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