Treatment of instrumental oesophageal perforation.

Wesdorp, I. C. E.; Bartelsman, J. F. W. M.; Jager, F.C.; Tytgat, G. N. J.

doi:10.1136/gut.25.4.398

Cited by 105 publications

(38 citation statements)

References 24 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

264

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

264

232

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“…Most authors suggest early surgical closure of the esophageal fistula and drainage of the contaminated area 4,11,12 . However, good results have also been reported with conservative approaches [13][14][15] . Our patient had a thoracotomy done on her a week after arriving in hospital, and the foreign body was removed, but the fistula was not repaired and was left to heal on its own with an NG tube insitu.…”

Section: Discussionmentioning

confidence: 94%

rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum

Byaruhanga¹,

Kakande²,

Mwambu³

2013

Af Hlth Sci

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A 6-year-old girl was referred to the ENT (Ear nose and throat) unit at Mulago National Referral Hospital with a foreign body in the esophagus diagnosed by routine chest radiograph. The child's parents recall she had ingested a round object (galvanised iron umbrella cap of a roofing nail) two years prior to this, but they thought that the child had passed it out in stool since she had continued eating and swallowing normally. On arrival at the National referral hospital, the child had two esophagoscopies done but the foreign body was not seen, not until a barium swallow was done was it confirmed that the FB(foreign body) had perforated the esophagus and entered the mediastinum. The cardiothoracic surgeons were consulted, and they removed the foreign body via a thoracotomy. The child recovered well and was discharged from hospital on day 55.

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“…It includes 1) Nil per os, 2) intravenous antibiotics, 3) nasogastric decompression, 4) enteral nutrition and 5) insertion of chest tube .Cameron et al [15] proposed three criteria for nonoperative management: 1) perforation must be contained in the mediastinum and should be drained back into the esophagus; 2) there are mild symptoms; and 3) there should be minimal evidence of clinical sepsis. Wesdrop et al reported a series of 49 patients with endoscopic perforations treated non-operatively with a 6% mortality [16].…”

Section: Discussionmentioning

confidence: 99%

Esophageal Perforation Management: A Single-Center Experience

Ramzi¹,

Berjaud²,

Renaud³

et al. 2012

OJTS

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Background: Esophageal perforation is a rare and potentially life-threatening condition requiring urgent management. Successful therapy depends on the underlying etiology, clinical presentation, the time between rupture and diagnosis, the extent of the rupture and the underlying health of the patient. Method: From 2005 to 2012, the author retrospectively analyzed 36 patients treated for esophageal perforation. Data were evaluated for cause of perforation, symptoms, comorbidities, the method of diagnosis, delay in diagnosis, therapeutic regimen, complications, hospital stay, follow-up and mortality. Results: The cause of perforation were iatrogenic in 14 cases (38.8%), foreign body ingestion in 11 (30.5%), spontaneous in 9 (25%), chest trauma in 1 (2.8%) and esophageal cancer in 1 case (2.8%). The most frequent signs and symptoms were chest pain in 27 cases (75%), fever in 15 (41.6%), dysphagia in 11 (30.5%), mediastinitis in 9 (25%) and vomiting in 8 (22%). The treatment included surgery in 26 cases (72.2%) which consists of thoracotomy (right or left), with or without esophageal suturing, washing, drainage with three chest tubes, jejunostomy and gastrostomy. The second group were patients treated medically in 10 cases (27.8%), medical treatment includes nil per os (NPO), parenteral nutrition, intravenous antibiotics and observation. Complications include fever (n = 14), auricular fibrillation (n = 7), esophageal fistula (n = 3), reoperation (n = 2), renal failure (n = 2), cerebrovascular accident (n = 1), pulmonary embolism (n = 1), pneumonia (n = 1) and deep vein thrombosis (n = 1). The average hospital stay for patients treated surgically was 36 days and for patients treated medically was 14.2 days. The overall mortality was 25% involving 8 patients treated surgically and 1 patient treated medically. Conclusion: The treatment method still must be chosen on an individual basis. Rapid diagnosis of this often life threatening condition is critical for expediting the choice of an optimal treatment strategy, whether surgical or non-surgical.

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Treatment of instrumental oesophageal perforation.

Cited by 105 publications

References 24 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

rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum

Esophageal Perforation Management: A Single-Center Experience

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