Endoscopic closure of acute Boerhaave’s syndrome with an over-the-scope clip

Vinnamala, Sudheer; Menon, Vinod; Arasaradnam, Ramesh P.; Eaden, Jayne; Wong, John; Mannath, Jayan

doi:10.1055/s-0034-1377535

Cited by 6 publications

(3 citation statements)

References 2 publications

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“…Concerning BS, case series also demonstrate that endoscopic management represents a valuable option [ 11 , 12 ]. Table 1 summarizes the main characteristics and patients' outcome of several case reports of BS managed with OTSC published over the last decade, emphasizing the efficacy of the procedure with no reported direct complications [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip

Estorninho

Pimentel

Gravito-Soares

et al. 2022

GE Port J Gastroenterol

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Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.

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Section: Discussionmentioning

confidence: 99%

Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip

Estorninho

Pimentel

Gravito-Soares

et al. 2022

GE Port J Gastroenterol

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“…[11] A newer modality is the use over-the-scope clips to close the esophageal tear. [12][13][14] Three separate case reports describe successful management of Boerhaave's syndrome with overthe-scope clips, although two out of three patients only had pneumomediastinum without any pleural contamination.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome is a safe and effective treatment

Yeo

Hai

Hua

et al. 2016

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Boerhaave Syndrome, also known as spontaneous esophageal rupture, is a rare condition with an estimated mortality of 20%-40%. Conventional surgical repair with the intention of primary repair remains the mainstay of treatment in esophageal rupture in Boerhaave syndrome. We present our experience with 2 cases that underwent laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome. Both cases presented with left chest and abdominal pain after vomiting, and were normotensive on admission. In both cases, the diagnosis of Boerrhaave Syndrome were made on Computer Tomographic (CT) scan. The patients underwent laparoscopic repair of the esophageal rupture successfully, and were subsequently discharged well on post-operative day 13 and 15 respectively. The laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome results in shorter length of hospital stay. The mean length of stay in the laparoscopic approach was 14 days (13 & 15days) in our series, as opposed to a mean of 20.5 days in patients who underwent open thoracotomy and washout with primary repair. There were no mortalities in either of the patients who underwent laparoscopic transhiatal repair in our series, however open thoracotomy and primary repair was associated with a mortality of 20%. The rarity of a ruptured esophagus makes comparison between the various treatment methods difficult. From our own experience and successful outcome in 2 such patients, we conclude that laparoscopic transhiatal repair of Boerhaave syndrome is a safe alternative to open repair in patients as the rupture often occurs in the lower end of the esophagus, provided there are no contraindications to laparoscopy.

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“…There have been several reports about cases in which Boerhaave’s syndrome was successfully managed with a self-expandable metallic stent [ 6 – 10 ]. Recently, endoscopic closure using a clipping device has also been reported [ 11 – 13 ], but surgical treatment is usually selected, as advanced mediastinal intrapleural contamination by the contents of the gastrointestinal tract is often seen at the initial examination. Regarding surgery for spontaneous esophageal rupture, previous reports have suggested that most procedures are performed via a thoracotomy or laparotomy, and there have been few reports about camera-assisted operations being performed for spontaneous esophageal rupture.…”

Section: Case Presentationmentioning

confidence: 99%

Primary closure of a spontaneous esophageal rupture under hand-assisted laparoscopy: a case report

et al. 2016

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Spontaneous rupture of the esophagus, which is also known as Boerhaave’s syndrome, is a rare life-threatening condition that requires urgent surgical management. The optimal treatment involves surgical repair of the esophageal defect, which is usually accomplished via laparotomy, thoracotomy, or both, and mediastinal debridement. Here, we report a case of spontaneous rupture of the esophagus that was treated with suturing repair and drain insertion using a hand-assisted laparoscopic approach.

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Endoscopic closure of acute Boerhaave’s syndrome with an over-the-scope clip

Cited by 6 publications

References 2 publications

Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip

Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip

Laparoscopic transhiatal repair of esophageal rupture in Boerhaave Syndrome is a safe and effective treatment

Primary closure of a spontaneous esophageal rupture under hand-assisted laparoscopy: a case report

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