Boerhaave syndrome treated with endoscopic suturing

Chen, Alan; Kim, Woojin

doi:10.1016/j.vgie.2018.12.005

Cited by 7 publications

(2 citation statements)

References 3 publications

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“…Alternative endoscopic modalities to treat esophageal perforations are through or over-the-scope clips, endoscopic suturing devices and the novel endoluminal vacuum therapy, although the literature is limited to case reports and small case series. Clips may be sufficient for small to moderate sized perforations up to 2 cm, while endoscopic suturing can be applied for larger defects [ 46 - 48 ]. Endoscopic vacuum treatment has been evaluated in small trials, including patients with Boerhaave syndrome, and seems to be a safe and feasible option, with the limitation of the need for frequent sponge changes [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of esophageal stents as a primary therapeutic option in spontaneous esophageal perforations: a systematic review and meta-analysis of observational studies

Margaris

2024

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Background Spontaneous esophageal perforation traditionally mandates urgent surgical treatment. Lately, esophageal stents have been used to reduce the associated morbidity and mortality. The current systematic review aimed to assess the efficacy of stents as a primary treatment option in this scenario. Methods A systematic search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library for studies published in the English language between 2000 and 2023. We included observational studies reporting on the use of stents, alongside conservative measures and drainage procedures, in patients with spontaneous esophageal perforations. Primary outcomes were sealing rate (persistent leak occlusion) and failure rate (mortality or conversion to a major surgical operation). Secondary outcomes included patients’ presentation, sepsis, drainage procedures, and reinterventions. Results for primary outcomes were presented as pooled rates with 95% confidence intervals (CIs), using a random-effects model. Methodological quality was assessed using the MINORS score. Results Eighteen studies involving 171 patients were included. Sealing rate was 86% (95%CI 77-93%) and failure rate was 14% (95%CI 7-22%). Weighted mortality rate was 6% (95%CI 2-13%), while conversion to surgical treatment was 2% (95%CI 0-9%). Late presentation was not related to a statistically significant increase in treatment failure (odds ratio 1.85, 95%CI 0.37-9.30; P=0.72). Drainage procedures were required for the majority of patients, with a high rate of surgical and endoscopic reinterventions. Conclusions Our results imply that stents may offer an effective and safe alternative treatment for patients with spontaneous esophageal perforations. Additional endoscopic and surgical drainage procedures are frequently needed.

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Section: Discussionmentioning

confidence: 99%

Efficacy of esophageal stents as a primary therapeutic option in spontaneous esophageal perforations: a systematic review and meta-analysis of observational studies

Margaris

2024

aog

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“…Endoscopy is a proven effective method in the diagnosis of Boerhaave’s syndrome, particularly in cases in which the diagnosis is suspected but findings on CT are inconclusive, because endoscopy enables specific lesion characterization. Regarding endoscopic treatment, different therapeutic mechanisms can be proposed: closing with over-the-scope clips [ 9 , 10 ], endoscopic ligation with snare loops [ 11 ], derivation indwelling esophageal stent [ 12 , 13 ], and placement of open-pore polyurethane foam or luminal sponge [ 14 , 15 ]. From the perspective of trauma degree, endoscopic management is reserved for treatment of inoperable patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series

Wang

Chen

2021

J Med Case Reports

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Background Boerhaave’s syndrome is the spontaneous rupture of the esophagus, which requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging. Case presentation Case 1: A 54-year-old Chinese man presented to us with sudden-onset epigastric pain radiating to the back following hematemesis. Upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. Subsequent computed tomography showed frank pneumomediastinum and heterogeneous pleural effusion. Immediately, esophageal perforation repair operation and jejunostomy were performed. The postoperative period was uneventful, and he was discharged. Case 2: A 62-year-old Chinese man was admitted to the emergency department with thoracic dull pain and chest distress. Chest computed tomography scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His postoperative period was uneventful, with no leakage or stricture. Case 3: The patient was a 69-year-old Chinese male presenting with severe retrosternal and upper abdominal pain following an episode of forceful vomiting. Thoracic computed tomography scan revealed a rupture in the left distal part of the esophagus, a pneumomediastinum, and left-sided pleural effusions. Conservative treatment failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery. Conclusions We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

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The Use of the Overstitch to Close Perforations and Fistulas

Thompson

2020

Gastrointestinal Endoscopy Clinics of North America

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Gastrointestinal perforations are defined as an acute full-thickness defect of the gastrointestinal tract. 1 Perforation can occur as a result of a full-thickness injury, or progression from a partial thickness injury. Spontaneous perforations can result from a variety of etiologies including Boerhaave syndrome, ulcers, malignancy, diverticulitis, radiation therapy, inflammatory bowel disease, and intestinal ischemia. Traumatic perforations can result from direct blunt or penetrating trauma, or from foreign body ingestion. Accidental perforations are an uncommon but feared complication of endoscopic procedures, primarily those that are therapeutic in nature, such as in endoscopic dilation and resection. Etiologies of perforations are listed in Box 1.Leaks are defined as a disruption in surgical anastomosis or closure, resulting in the egress and accumulation of luminal contents. 2 Leaks most often occur in an acute postoperative setting from gastrointestinal surgical procedures including intestinal resections and bariatric *

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Boerhaave syndrome treated with endoscopic suturing

Cited by 7 publications

References 3 publications

Efficacy of esophageal stents as a primary therapeutic option in spontaneous esophageal perforations: a systematic review and meta-analysis of observational studies

Efficacy of esophageal stents as a primary therapeutic option in spontaneous esophageal perforations: a systematic review and meta-analysis of observational studies

Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series

The Use of the Overstitch to Close Perforations and Fistulas

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