Use of Large-Diameter Metallic Stents to Seal Traumatic Nonmalignant Perforations of the Esophagus

Siersema, Peter D.; Homs, Marjolein Y.V.; Haringsma, Jelle; Tilanus, H. W.; Kuipers, Ernst J.

doi:10.1067/s0016-5107(03)00008-7

Cited by 150 publications

(99 citation statements)

References 21 publications

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“…The patient has not relapsed over the last 2 years. The present case along with published reports of stent use in cases of Boerhaave's syndrome [15,16] and iatrogenic perforation of esophageal malignancies [17] provides a compelling argument for extending this method to the conservative management of esophageal rupture of benign strictures. Fig.…”

Section: Discussionmentioning

confidence: 84%

Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients

et al. 2008

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The purpose of this study was to evaluate the effectiveness of temporary metallic stenting in 55 patients with treatment-resistant benign esophageal strictures and to identify factors associated with clinical outcomes. Under fluoroscopic guidance, covered retrievable stents were placed in 55 patients with benign esophageal strictures and were removed with retrieval hook 1 week to 6 months after placement. Stent placement was successful in all patients, and the mean dysphagia score was reduced from 2.8 to 1.3 (p<0.001). The most common complications were tissue hyperproliferation (31%), severe pain (24%), and stent migration (25%). During follow-up (mean: 38 months), recurrence of the stricture necessitating balloon dilation was seen in 38 (69%) of 55 patients. Maintained patency rates after temporary stenting at 1, 3, and 6 months and 1, 2, and 4 years were 58%, 43%, 38%, 33%, 26%, and 21%, respectively. In multivariate analysis, length (p=0.003) of the stricture was the only significant factor associated with maintained patency after temporary stenting. In conclusion, temporary metallic stenting for refractory benign esophageal strictures may be effective during the period of stent placement, but is disadvantaged by the high recurrence rates after stent removal, particularly in patients with a long length of stricture (>7 cm).

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Section: Discussionmentioning

confidence: 84%

Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients

et al. 2008

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“…Siersema et al [20] reported 5 Boerhaave patients out of 11 oesophagus perforations treated with metallic endoprothesis. Patients were treated with endoprothesis and one or both pleural cavities drained with chest tubes.…”

Section: Resultsmentioning

confidence: 99%

Spontaneous Rupture of the Oesophagus: Boerhaave’s Syndrome in 2008

Schipper

Gunne²,

Oostvogel³

et al. 2009

Dig Surg

175

160

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Objective: Boerhaave’s syndrome is a spontaneous rupture of the oesophagus with a lack of diagnostic and treatment consistency in the literature. Therefore, we reviewed all published literature in order to design a treatment algorithm based on the literature. Study Design: A systematic literature review written in the English language since 1975. Results: We reviewed all known literature. Treatment of the Boerhaave syndrome was divided into three categories: conservative, endoscopic and surgical approach. The survival rate of all treatments was 75, 100 and 81%, respectively. Conclusion: Boerhaave’s syndrome should be treated endoscopically when diagnosed within 48 h and when there are no signs of sepsis. However, when a patient is diagnosed within 48 h and has a septic profile, thoracotomy with hemifundoplication and pleural/mediastinal drainage should be performed; and in case of intra-abdominal leakage, a laparotomy for local repair should be performed. When a patient is diagnosed after 48 h, conservative treatment should be followed and only when a patient gets a septic profile is surgical treatment indicated.

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“…Siersema et al [17] report on good results using large diameter stents in the treatment of traumatic non-malignant perforations of the oesophagus and conclude that metallic large diameter stents can be safely used in this patient population, provided that there is no uncontrolled spread of the infection to the mediastinum and/or pleural cavities and broad-spectrum antibiotics are administered.…”

Section: Discussionmentioning

confidence: 99%

Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis

et al. 2009

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The case of an upper oesophageal perforation as a concomitant injury of an isolated fracture of the upper thoracic spine without neurological compromise has not been described so far. A Case report and review of the literature is presented here. Concomitant oesophageal perforations carry a high risk of being missed initially. CT alone can visualize the subtle indirect signs like peri-oesophageal air. The literature revealed that only peri-oesophageal air might be a valid indicator of oesophageal injury. There are no systematic data on thoracic spine fractures with concomitant oesophageal perforations. Mediastinitis secondary to oesophageal perforation might be treated conservatively with endoscopic stent placement rather than surgically. As the radiological signs of concomitant soft tissue injury, like oesophageal perforations, in fractures of the upper thoracic spine are subtle and easily missed initially only anticipation of concomitant injuries by the treating physician based on the trauma mechanism ensures a timely diagnosis.

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Use of Large-Diameter Metallic Stents to Seal Traumatic Nonmalignant Perforations of the Esophagus

Cited by 150 publications

References 21 publications

Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients

Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients

Spontaneous Rupture of the Oesophagus: Boerhaave’s Syndrome in 2008

Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis

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