Nonsurgical treatment of esophageal perforations after endoscopic palliation in advanced esophageal cancer.
OBJECTIVE
Iatrogenic esophageal perforation during palliative endoscopic treatment in patients with incurable esophageal or cardiac cancer is a severe complication, associated with a high rate of mortality. The treatment remains controversial, since both nonsurgical and surgical treatment regimens are used. The present study describes a nonsurgical regimen.


METHODS
Nine cases of perforation occurred in 142 consecutive patients referred for endoscopic palliation of dysphagia, corresponding to a perforation rate of 6%. Laser therapy was the main treatment used (argon plasma coagulation or Nd:YAG photocoagulation).


RESULTS
Nonsurgical treatment was successful in six patients (75%). Two patients died (22%) as a direct result of esophageal perforation following endoscopic palliation procedures.


CONCLUSIONS
These findings show an acceptable mortality rate using a nonsurgical treatment regimen involving broad-spectrum antibiotics, nasogastric suction, and parenteral nutrition, with pleural drainage and endoprosthesis placement in addition when indicated.
Bisgaard
T
T
Dept. of Surgical Gastroenterology, Rigshospitalet, National University Hospital, Copenhagen, Denmark.
Wøjdemann
M
M
Heindorff
H
H
Svendsen
L B
LB
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004106:Dilatation / Q000009:adverse effects*; D004564:Electrocoagulation; D004938:Esophageal Neoplasms / Q000150:complications* / Q000628:therapy; D004939:Esophageal Perforation / Q000209:etiology / Q000628:therapy*; D004940:Esophageal Stenosis / Q000628:therapy*; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012189:Retrospective Studies; D015607:Stents