Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation
BACKGROUND: Spontaneous esophageal perforation is a challenging surgical emergency with significant morbidity and mortality, and timely primary repair carries good outcomes. However, direct repair for a delayed spontaneous esophageal perforation is not always feasible and is associated with high mor...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10089877/ https://www.ncbi.nlm.nih.gov/pubmed/37065549 http://dx.doi.org/10.21037/jtd-22-1316 |
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author | Chiu, Chien-Hung Leow, Osbert Qi Yao Wang, Yu-Chao Chen, Wei-Hsun Fang, Hsin-Yueh Chao, Yin-Kai Lin, Jules |
author_facet | Chiu, Chien-Hung Leow, Osbert Qi Yao Wang, Yu-Chao Chen, Wei-Hsun Fang, Hsin-Yueh Chao, Yin-Kai Lin, Jules |
author_sort | Chiu, Chien-Hung |
collection | PubMed |
description | BACKGROUND: Spontaneous esophageal perforation is a challenging surgical emergency with significant morbidity and mortality, and timely primary repair carries good outcomes. However, direct repair for a delayed spontaneous esophageal perforation is not always feasible and is associated with high mortality. Esophageal stenting can provide therapeutic benefits in the management of esophageal perforations. In this study, we review our experience with placing esophageal stents in combination with minimally-invasive surgical drainage to treat delayed spontaneous esophageal perforations. METHODS: We retrospectively analyzed patients with delayed spontaneous esophageal perforations between September 2018 and March 2021. All patients were treated using a hybrid approach, including esophageal stenting across the gastroesophageal junction (GEJ) to reduce continued contamination, gastric decompression with extraluminal sutures to prevent stent migration, early enteral nutrition, and aggressive minimally-invasive thoracoscopic debridement and drainage of infected material. RESULTS: There were 5 patients with delayed spontaneous esophageal perforation treated with this hybrid approach. The mean duration between symptoms and diagnosis was 5 days, and the interval between symptoms and esophageal stent insertion was 7 days. The median time to oral nutrition and to esophageal stent removal was 43 and 66 days. There was no stent migration or hospital mortality. Three patients (60%) had postoperative complications. All patients were successfully resumed on oral nutrition with esophageal preservation. CONCLUSIONS: A hybrid approach combining endoscopic esophageal stent placement with extraluminal sutures to prevent stent migration, thoracoscopic decortication with chest tube drainage, gastric decompression, and jejunostomy tube placement for early nutrition was feasible and effective in the treatment of delayed spontaneous esophageal perforations. This technique offers a less invasive treatment approach for a challenging clinical problem which has traditionally carried a high rate of morbidity and mortality. |
format | Online Article Text |
id | pubmed-10089877 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-100898772023-04-13 Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation Chiu, Chien-Hung Leow, Osbert Qi Yao Wang, Yu-Chao Chen, Wei-Hsun Fang, Hsin-Yueh Chao, Yin-Kai Lin, Jules J Thorac Dis Original Article BACKGROUND: Spontaneous esophageal perforation is a challenging surgical emergency with significant morbidity and mortality, and timely primary repair carries good outcomes. However, direct repair for a delayed spontaneous esophageal perforation is not always feasible and is associated with high mortality. Esophageal stenting can provide therapeutic benefits in the management of esophageal perforations. In this study, we review our experience with placing esophageal stents in combination with minimally-invasive surgical drainage to treat delayed spontaneous esophageal perforations. METHODS: We retrospectively analyzed patients with delayed spontaneous esophageal perforations between September 2018 and March 2021. All patients were treated using a hybrid approach, including esophageal stenting across the gastroesophageal junction (GEJ) to reduce continued contamination, gastric decompression with extraluminal sutures to prevent stent migration, early enteral nutrition, and aggressive minimally-invasive thoracoscopic debridement and drainage of infected material. RESULTS: There were 5 patients with delayed spontaneous esophageal perforation treated with this hybrid approach. The mean duration between symptoms and diagnosis was 5 days, and the interval between symptoms and esophageal stent insertion was 7 days. The median time to oral nutrition and to esophageal stent removal was 43 and 66 days. There was no stent migration or hospital mortality. Three patients (60%) had postoperative complications. All patients were successfully resumed on oral nutrition with esophageal preservation. CONCLUSIONS: A hybrid approach combining endoscopic esophageal stent placement with extraluminal sutures to prevent stent migration, thoracoscopic decortication with chest tube drainage, gastric decompression, and jejunostomy tube placement for early nutrition was feasible and effective in the treatment of delayed spontaneous esophageal perforations. This technique offers a less invasive treatment approach for a challenging clinical problem which has traditionally carried a high rate of morbidity and mortality. AME Publishing Company 2023-03-10 2023-03-31 /pmc/articles/PMC10089877/ /pubmed/37065549 http://dx.doi.org/10.21037/jtd-22-1316 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Chiu, Chien-Hung Leow, Osbert Qi Yao Wang, Yu-Chao Chen, Wei-Hsun Fang, Hsin-Yueh Chao, Yin-Kai Lin, Jules Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
title | Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
title_full | Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
title_fullStr | Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
title_full_unstemmed | Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
title_short | Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
title_sort | esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10089877/ https://www.ncbi.nlm.nih.gov/pubmed/37065549 http://dx.doi.org/10.21037/jtd-22-1316 |
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