Esophageal Stent Placement for the Treatment of Spontaneous Esophageal Perforations

• Published in: The Annals of thoracic surgery Vol. 88; no. 1; pp. 194 - 198
• Main Authors: Freeman, Richard K., MD, Van Woerkom, Jaclyn M., RN, BSN, Vyverberg, Amy, RN, BSN, Ascioti, Anthony J., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2009
• Subjects: Adult; Aged; Cardiothoracic Surgery; Contrast Media; Esophageal Perforation - diagnostic imaging; Esophageal Perforation - surgery; Esophagoscopy - methods; Female; Follow-Up Studies; Humans; Length of Stay; Male; Manometry; Middle Aged; Minimally Invasive Surgical Procedures - methods; Pain Measurement; Pain, Postoperative - physiopathology; Prospective Studies; Risk Assessment; Severity of Illness Index; Stents; Surgery; Tomography, X-Ray Computed - methods; Treatment Outcome; 8
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.04.004

Background Traditional therapy for spontaneous esophageal perforation has most often been urgent operative repair. This investigation summarizes the treatment of spontaneous perforations of the esophagus using an occlusive removable esophageal stent. Methods During a 48-month period, patients with a spontaneous esophageal perforation were offered endoluminal esophageal stent placement as the initial therapy instead of operation. Excluded were patients with an esophageal malignancy or a chronic esophageal fistula. Silicone-coated stents were placed endoscopically using general anesthesia and fluoroscopy. Adequate drainage of infected areas was achieved. Leak occlusion was confirmed by esophagram. Results Twenty-one esophageal stents were placed in 19 patients for spontaneous esophageal perforations. Associated endoscopic (n = 19) or surgical procedures (n = 9) were also simultaneously performed. Leak occlusion occurred in 17 patients (89%). Fifteen patients (79%) were able to initiate oral nutrition within 72 hours of stent placement. Two patients (10%) with a perforation extending across the gastroesophageal junction experienced a continued leak after stent placement and underwent operative repair. Stent migration in 4 patients (21%) required repositioning (n = 4) or replacement (n = 2). Stents were removed at a mean of 20 ± 15 days after placement. Hospital length of stay was 9 ± 12 days. Conclusions Endoluminal esophageal stent placement is an effective treatment of most spontaneous esophageal perforations. These stents result in rapid leak occlusion, provide the opportunity for early oral nutrition, may significantly reduce hospital length of stay, are removable, and avoid the potential morbidities of operative repair.