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...

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Autores principales: Chiu, Chien-Hung, Leow, Osbert Qi Yao, Wang, Yu-Chao, Chen, Wei-Hsun, Fang, Hsin-Yueh, Chao, Yin-Kai, Lin, Jules
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
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.
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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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