Management of Esophageal Perforation in 120 Consecutive Patients: Clinical Impact of a Structured Treatment Algorithm

Lindenmann, Joerg; Matzi, Veronika; Neuboeck, Nicole; Anegg, Udo; Maier, Andrea B.; Smolle, Josef; Smolle‐Jüttner, Freyja‐Maria

doi:10.1007/s11605-012-2070-8

Cited by 53 publications

(44 citation statements)

References 24 publications

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“…Stent placement has a combined morbidity of 34 %, most often from stent migration. Endoscopic reintervention and surgical intervention were required in 25 and 13 % of patients, respectively [17]. Tracheostomy tube placement, post-operative infection, and a recurrent leak followed operative repair in 22, 53, and 50 % of patients, respectively [18,19].…”

Section: Discussionmentioning

confidence: 99%

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

et al. 2015

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Section: Discussionmentioning

confidence: 99%

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

et al. 2015

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“…In general a specialist multidisciplinary approach, considering the patients' condition on one hand and the particular characteristics and dynamics of the oesophageal perforation on the other hand, is the key to an optimal treatment [215,[218][219][220][221][222][223].…”

Section: Diagnosismentioning

confidence: 99%

“…Over time a clear treatment shift towards less invasive treatment options can be observed [52,215,[217][218][219][220][221][222][223].…”

Section: Diagnosismentioning

confidence: 99%

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Abu‐Omar

Kocher

Bosco

et al. 2017

Eur J Cardiothorac Surg

153

177

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Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.

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“…We have identified 17 patients with this clinical problem treated at a tertiary care center over a 10-year period which correlates with other series in comparable centers 10 11 12. Minimally invasive surgical intervention is increasing, as is endotherapy for the treatment of many gastrointestinal pathologies, including esophageal perforation and esophageal anastomotic leak.…”

Section: Discussionmentioning

confidence: 75%

Utility of endoscopic therapy in the management of Boerhaave syndrome

et al. 2016

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Background/aims: The optimal intervention for Boerhaave perforation has not been determined. Options include surgical repair with/without a pedicled muscle flap, T tube placement, esophageal resection or diversion, or an endoscopic approach. All management strategies require adequate drainage and nutritional support. Our aim was to evaluate outcomes following Boerhaave perforation treated with surgery, endoscopic therapy, or both. Patients and methods: We performed a 10-year review of our prospectively maintained databases of adult patients with Boerhaave perforations. We documented clinical presentation, extent of injury, primary intervention, “salvage” treatment (any treatment for persistent leak), and outcome. Results were analyzed using the Fisher’s exact and Kruskal – Wallis tests. Results: Between October 2004 and October 2014, 235 patients presented with esophageal leak/fistula with 17 Boerhaave perforations. Median age was 68 years. Median length of perforation was 1.25 cm (range 0.8 – 5 cm). Four patients presented with systemic sepsis (two treated with palliative stent and two surgically). Primary endotherapy was performed for eight (50 %) and primary surgery for eight (50 %) patients. Two endotherapy patients required multiple stents. Median stent duration was 61 days (range 56 – 76). “Salvage” intervention was required in 2/8 (25 %) endotherapy patients and 1/8 (13 %) surgery patient (stent). All patients healed without resection/reconstruction. There were no deaths in the surgically treated group and two in the endotherapy group (stented with palliative intent due to poor systemic condition). Readmission within 30 days occurred in 3/6 of alive endotherapy patients (50 %) and 0/8 surgery patients. Re-intervention within 30 days was required for one endotherapy patient. Conclusion: Endoscopic repair of Boerhaave perforations can be useful in carefully selected patients without evidence of systemic sepsis. Endoscopic therapy such as stenting is particularly valuable as a “salvage” intervention. The benefits of endoscopic therapy and esophageal preservation are offset against an increased risk of readmission in patients primarily treated endoscopically.

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Management of Esophageal Perforation in 120 Consecutive Patients: Clinical Impact of a Structured Treatment Algorithm

Cited by 53 publications

References 24 publications

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Utility of endoscopic therapy in the management of Boerhaave syndrome

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