Treatment of spontaneous esophageal rupture with a covered self-expanding metal stent

Spontaneous esophageal rupture responding to simple suture closure, drainage, and percutaneous endoscopic gastrostomy (PEG): case report

“…Some studies have advocated that drainage of the thoracic cavity alone in selected patients facilitates conservative therapy [7,8]. Because of recent advances in stents, conservative therapy is increasingly performed [9,10].…”

Stent placement in the management of oesophageal leaks

“…After the establishment of stent use as palliative treatment for malignant oesophageal strictures [1][2][3], there have sporadically been publications concerning stent placement for managing oesophageal leaks or perforations [4][5][6][7][8][9].…”

“…Regarding oesophageal perforation, a life-threatening entity with mortality rates up to 30% with surgical treatment, conservative treatment remains controversial while sporadic cases with good outcome after prosthesis insertion have been reported [4][5][6].…”

To stent or not to stent?

“…Several recent reports have also presented limited experience using expandable metal stents to seal benign TE fistulae and spontaneous esophageal rupture (Boerhaave's syndrome) (17)(18)(19)(20). Dumonceau et al reported three patients with benign esophageal fistulae; etiologies included radiation-induced ischemia, erosion of a tracheostomy cannula, and a postoperative fistula after repair of a traumatic bronchial rupture in a child (17).…”

“…Autopsy showed ischemic necrosis of the esophagus, presumed to be secondary to the high radial expansile force of the Wallstent (18) Covered Ultraflex (Boston Scientific/Microvasive, Natick, MA) stents were used in two other cases. The patients recovered and the stents were endoscopically removed on an elective basis (19,20). The design of the Ultraflex stent may afford a chance at improved outcome, given its relatively low expansile force and smooth knitted ends.…”