Management of Esophageal Perforations after Therapeutic Upper Gastrointestinal Endoscopy

Adamek, Henning E.; Jakobs, Ralf; Dorlars, D.; Martin, W.-R.; Kromer, Meghan; Riemann, Jürgen F.

doi:10.3109/00365529709025073

Cited by 41 publications

(40 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 Despite improvement in diagnostic procedures and (surgical) interventions, ruptures and leaks in the oesophagus are still potentially life-threatening injuries associated with a high morbidity and mortality if treated surgically. [2][3][4][5][6][7][8] Surgical treatment has long been the 'gold standard' for these emergencies. 1,5,[9][10][11][12] Over the past few years, new minimally invasive endoscopic treatment options have emerged, i.e.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

259

232

View full text Add to dashboard Cite

Summary Background Placement of self‐expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs. Methods A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Results Twenty‐five studies, including 267 patients with complete follow‐up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent‐related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in‐ and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68]. Conclusions Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6–8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self‐expanding plastic stents and fully covered self‐expanding metal stents) and, to a minor degree, on expected risk of tissue in‐ or overgrowth (partially covered self‐expanding metal stents).

show abstract

Section: Discussionmentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

259

232

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5] Iatrogenic main cause is diagnostic endoscopy like endoscopic biopsy and therapeutic endoscopy such as endoscopic dilatations, variceal sclerotherapy, endoscopic laser therapy, endoscopic photodynamic therapy, endoscopic stent, nasogastric tube placement, endotracheal intubations, transoesophageal echocardiography, echocardiography, mini-tracheostomy. operative endoscopy like aortic aneurysm, cervical disk surgery, thoracic surgery, achalasia.…”

Section: Etiologymentioning

confidence: 99%

“…[7][8][9][10] In case the diagnosis of perforation is made within 24 hours, the treatment of choice is primary closure of the perforation site and wide drainage of the mediastinum. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Esophageal perforations are dramatic complications and if managed improperly result in mortality. Proper management requires an appreciation of the anatomy, the etiology and the pathophysiology of this entity.…”

Section: Introductionmentioning

confidence: 99%

“…And it increases to 40-60% among those who receive treatment after two days. [1][2][3][4][5][6] Typical structure and placement of esophagus leads to infection by bacteria easily as well as damage by digestive enzymes can occur which in turn can lead to increased mortality. 7 But fortunately this condition of esophageal perforation is rare.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Approach and management modalities in Esophageal Perforations

et al. 2018

View full text Add to dashboard Cite

Esophageal perforation leads to increased morbidity and mortality. Treatment of choice is debatable. In adult cases of esophageal perforation, the important causes can be due to trauma, or due to foreign body or due to iatrogenic and sometimes it may be spontaneous. The rate of morbidity and mortality is increased among those who fall prey to delayed diagnosis and delayed treatment. Even after the proper treatment started within one day of diagnosis, the death rate can be 10-25%. And it increases to 40-60% among those who receive treatment after two days. In case the diagnosis of perforation is made within 24 hours, the treatment of choice is “primary closure of the perforation site and wide drainage of the mediastinum”. On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. Now a days conservative method of management is more or less adopted especially patients with small size perforation and minimum involvement of extra esophageal part. Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. Hence multi-disciplinary approach is recommended for proper outcome. Timing of intervention is extremely critical in ensuring low mortality. Diagnosis is difficult, and a high degree of suspicion is required, especially in pediatric patients. As Endoscopic therapists play an increasingly “important role in the management of upper digestive disease”, a proper understanding of this complication of therapy is required by the therapist and the attending surgeons. Management of such perforations are both non-operative and operative. Nonoperative management used for limited perforations without sepsis, while operative management is reserved for more florid perforations and those in whom obstruction distal to the perforation exists. Endoscopic intervention may save some patients from being operated upon.

show abstract

Spectrum of oesophageal perforations and their influence on management

Wahed

Dent

Jones

et al. 2014

Journal of British Surgery

View full text Add to dashboard Cite

Background: Oesophageal perforations are associated with high mortality and morbidity rates. A spectrum of aetiologies and clinical presentations has resulted in a variety of operative and non-operative management strategies. This analysis focused on the impact of these strategies in a single specialist centre.Methods: All patients with oesophageal perforation managed in a single oesophagogastric unit in the UK between January 2002 and December 2012 were identified. Gastric perforations and anastomotic leaks were excluded. Data were verified using an endoscopy database, electronic and paper records. Aetiology of perforation, management and outcomes were analysed.Results: There were 101 adult patients with oesophageal perforation. Complete records were not available for five patients and they were excluded from the analysis. The median age was 69·5 years. Thoracic perforations were present in 84 per cent of patients. There were 51 spontaneous perforations, 41 iatrogenic and four related to foreign bodies. Oesophageal malignancy was present in 11 patients. Forty-four patients were managed surgically, 47 without operation and five patients were considered unfit for active treatment. The in-hospital mortality rate for treated patients was 24 per cent and median length of hospital stay was 31·5 days. Conclusion:The management of oesophageal perforation requires specialist multidisciplinary input. It is best provided in an environment familiar with the range of treatment modalities. Management decisions should be guided primarily by the degree of contamination rather than the aetiology of the defect. The routine use of stents is unproven and controversial.

show abstract

Management of Esophageal Perforations after Therapeutic Upper Gastrointestinal Endoscopy

Abstract: The current concept in management of esophageal perforations comprises surgical as well as medical treatment. In well-selected cases, non-operative treatment can be considered with favorable results.

Cited by 41 publications

References 28 publications

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Approach and management modalities in Esophageal Perforations

Spectrum of oesophageal perforations and their influence on management

Contact Info

Product

Resources

About