Original article
General thoracic
Nonoperative Treatment of 15 Benign Esophageal Perforations With Self-Expandable Covered Metal Stents

https://doi.org/10.1016/j.athoracsur.2005.08.047Get rights and content

Background

Spontaneous or iatrogenic esophageal perforations after endoscopic procedures are potentially life-threatening events with a considerable mortality rate. The aim of this study was to demonstrate that a nonoperative endoscopic treatment with self-expanding metal stents may have a lower morbidity and mortality rate compared with surgical treatment.

Methods

A nonrandomized observational study was conducted with 15 consecutive patients between January 1997 and June 2004. Benign spontaneous and iatrogenic esophageal perforations after endoscopic procedures were treated with self-expandable metal stents.

Results

Seven patients (group 1) underwent stent insertion with an average time delay of 45 minutes. In 8 patients (group 2), the median delay was 123 hours. All patients in group 1 had an uneventful recovery and left hospital 5 days (range, 3 to 9) after stent insertion. One patient in group 2 (1 of 8) died of pneumonia after 6 days. In any other cases, perforations healed successfully after stent placement, but the clinical course was generally complicated with sepsis and multiple organ failure. The average hospital stay was 44 days (range, 15 to 70).

Conclusions

Immediate insertion of a self-expandable metal stent enables an excellent outcome with minimal mortality and morbidity without the need for operation. Even in cases of old esophageal perforations, sealing with self-expandable metal stents is still a good option although the clinical course is much less impressive than in early treated perforations.

Section snippets

Patients and Methods

In this retrospective nonrandomized observational study, 15 consecutive patients with benign esophageal perforations were treated with a self-expandable metal stent (Ultraflex; Boston Scientific, Natick, Massachusetts; or Niti-S-Stent; Taewoong Medical, Seoul, Korea) between January 1997 and June 2004. Informed consent was obtained from all patients prior to treatment. The study cohort was divided into two groups with respect to the elapsed time interval between diagnosis and treatment.

The

Results

In group 1, 6 of 7 patients could be discharged after an average hospital stay of 5 days. All patients were able to eat and drink normally, and no patient had a pleural empyema or signs of sepsis. Only 1 patient in group 1 had to be transferred to a general hospital for further rehabilitative treatment. Another patient needed an additional CT-guided abdominal drainage because of fluid accumulation close to the perforated esophagojejunostomy after bouginage. After application of an Ultraflex

Comment

In the case of benign esophageal perforations, various suture and patch techniques [9, 10, 11], diversion, and even esophageal resection [3, 6, 13] have been employed, but the outcome after surgical therapy remains disappointing [2, 3, 4, 5]. A well-known problem is the postoperative suture breakdown with consecutive anastomotic leaks. A 40% suture breakdown rate is reported in the case of nonbuttressed primary repair [10]. Suture breakdown can reach as high as 50% [24] if the repair is delayed

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