Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series.
BACKGROUND
Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention.


METHODS
Patients with paraesophageal abscesses were treated with EUS-guided or endoscopic mediastinal puncture if the abscess was >2 cm and sepsis was present. Abscess cavities were entered with a 9.5-mm endoscope after balloon dilation to allow irrigation and drainage. Debris was removed with a Dormia basket. Concomitant pleural effusions were treated with transthoracic drains. Patients received intravenous antibiotics and enteral/parenteral nutrition.


RESULTS
Twenty patients fulfilled the entry criteria. Simple drainage was sufficient in 4 cases, and puncture was impossible in one case. Of the 15 treated patients (age 39-76 years, 5 women) the etiology of perforation was Boerhaave's syndrome (n = 8), anastomotic leak (n = 3), and iatrogenic perforation (n = 4). Debridement was successful in all cases and required a median of 5 daily sessions (range 3-10). All patients became apyrexial, with a C-reactive protein < 5 mg/L within a median of 4 days (range 2-8 days). Esophageal defects were closed with endoclips (n = 7), fibrin glue (n = 4), metal stents (n = 1), or spontaneously healed (n = 3). One patient died from a massive pulmonary embolism one day after successful debridement (mortality 7%). No other complications were seen. Median follow-up was 12 months (range 3-40 months).


CONCLUSIONS
Nonoperative endoscopic transesophageal debridement of mediastinal abscesses appears safe and effective.
Wehrmann
Till
T
Department of Internal Medicine I, Klinikum Hannover-Siloah, Germany.
Stergiou
Nikos
N
Vogel
Bernd
B
Riphaus
Andrea
A
Köckerling
Ferdinand
F
Frenz
Markus B
MB
D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D019160:Endosonography / Q000379:methods*; D004939:Esophageal Perforation / Q000150:complications* / Q000000981:diagnostic imaging; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome