Original articleGeneral thoracicNonoperative Treatment of 15 Benign Esophageal Perforations With Self-Expandable Covered Metal Stents
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
References (30)
- et al.
Esophageal perforationa therapeutic challenge
Ann Thorac Surg
(1990) - et al.
Mortality from iatrogenic esophageal perforations is highexperience of 54 treated cases
Ann Chir
(2002) - et al.
Thoracic esophageal perforationsa decade of experience
Ann Thorac Surg
(2003) - et al.
Esophageal perforationa continuing challenge
Ann Thorac Surg
(1992) Esophageal perforations, anastomotic leaks, and stricturesthe role of prostheses
Am J Surg
(2001)- et al.
Selective nonoperative management of contained intrathoracic esophageal disruptions
Ann Thorac Surg
(1979) - et al.
Treatment of esophageal perforation with a covered expandable metal stent
Gastrointest Endosc
(1996) - et al.
Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus
Gastrointest Endosc
(2003) - et al.
Successful treatment of esophageal perforation with a removable self-expanding plastic stent
Am J Gastroenterol
(2001) - et al.
Successful management of a nonmalignant esophageal perforation with a coated stent
Ann Thorac Surg
(2002)
Diagnosis and recommended management of esophageal perforation and rupture
Ann Thorac Surg
Epidural abscessa delayed complication of esophageal stenting for benign stricture
Ann Thorac Surg
Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer
Gastrointest Endosc
Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy
Scand J Gastroenterol
Treatment of endoscopic esophageal perforation
Surg Endosc
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