title: Esophageal perforation management using a multidisciplinary minimally invasive treatment algorithm.
abstract: BACKGROUND
  The surgical management of esophageal perforation (EP) often results in mortality and significant morbidity. Recent less invasive approaches to EP management include endoscopic luminal stenting and minimally invasive surgical therapies. We wished to establish therapeutic efficacy of minimally invasive therapies in a consecutive series of patients.
  
  
  METHODS
  An IRB-approved retrospective review of all acute EPs between 2007 and 2013 at a single institution was performed. Patient demographic, clinical outcomes data, and hospital charges were collected.
  
  
  RESULTS
  We reviewed 76 consecutive patients with acute EP presenting to our tertiary care center. Median age was 64 ± 16 years (range 25 to 87 years), with 50 men and 26 women. Ninety percent of EPs were in the distal esophagus, with 67% of iatrogenic perforations occurring within 4 cm of the gastroesophageal junction. All patients were treated within 24 hours of initial presentation with a removable covered esophageal stent. Leak occlusion was confirmed within 48 hours of esophageal stent placement in 68 patients. Median lengths of ICU and hospital stay were 3 and 10 days, respectively (range 1 to 86 days). One-third of the patients were noted to have prolonged intubation (>7 days) and pneumonia that required a tracheostomy. One in-hospital (1.3%) mortality occurred within 30 days. Median total hospital charges for EP were $85,945.
  
  
  CONCLUSIONS
  Endoscopically placed removable esophageal stents with minimally invasive repair of the perforation and feeding access is an effective treatment method for patients with EP. This multidisciplinary method enabled us to care for severely ill patients while minimizing morbidity and mortality and avoiding open esophageal surgery.
authors: Department of Surgery, University of Florida, Gainesville, FL. Electronic address: kfir.bendavid@surgery.ufl.edu.
authors: Kfir
authors: K
authors: Ben-David
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: Kevin
authors: K
authors: Behrns
authors: Roswell Park Cancer Center, Buffalo, NY.
authors: Steven
authors: S
authors: Hochwald
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: Georgios
authors: G
authors: Rossidis
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: Angel
authors: A
authors: Caban
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: Cristina
authors: C
authors: Crippen
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: Thomas
authors: T
authors: Caranasos
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: Steven
authors: S
authors: Hughes
authors: Department of Medicine, University of Florida, Gainesville, FL.
authors: Peter
authors: P
authors: Draganov
authors: Department of Medicine, University of Florida, Gainesville, FL.
authors: Christopher
authors: C
authors: Forsmark
authors: Department of Medicine, University of Florida, Gainesville, FL.
authors: Shailendra
authors: S
authors: Chauhan
authors: Department of Medicine, University of Florida, Gainesville, FL.
authors: Mihir S
authors: MS
authors: Wagh
authors: Department of Surgery, University of Florida, Gainesville, FL.
authors: George
authors: G
authors: Sarosi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003661:Decision Support Techniques; D004322:Drainage / Q000191:economics / Q000379:methods; D004939:Esophageal Perforation / Q000191:economics / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy / Q000191:economics; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000191:economics; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007582:Jejunostomy / Q000191:economics; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome