title: Management and outcome of esophageal stenting for spontaneous esophageal perforations.
abstract: Treatment of spontaneous esophageal perforation (SEP) consists of different conservative, surgical and endoscopic treatment modalities. In this study, we evaluated the clinical efficacy and the outcome of covered self-expanding stent (CSES) treatment of SEP. All patients with SEP treated by CSES at our institution between 2005 and 2014 were included in this prospective single-center study. The data were collected from a prospective database based on clinical, endoscopic and operative reports. Follow-up data were procured by contacting the patients or their family doctors. The patient data were analyzed concerning course of treatment, leakage sealing rate, complications, and mortality. Patients with iatrogenic or malignant perforations were excluded. In total, 16 patients underwent endoscopic CSES placement for SEP between 2005 and 2014. Sealing of the leakage was immediately successful in 50% (8 patients). A second stent was placed in 5 patients, but did not achieve sealing of the perforation in any case, requiring a switch in treatment to a surgical procedure (n=4) or drainage of the persisting leakage (n=4). In-hospital mortality was 13%. Only delayed treatment was identified as a risk factor for inferior outcome. Patients with successful CSES treatment had a shorter ICU- and hospital stay and had a reduced risk of developing esophageal stenosis (RR: 0.4) or persisting dysphagia despite treatment (RR: 0.33). Endoscopic treatment of SEP is beneficial to the patient if immediately successful, but in our experience, failure rates are higher than described in the literature. Secondary placement of CSES was not successful when initial stent treatment failed, while both surgical intervention and drainage of the perforation showed good results in sealing the leakage.
authors: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors: Torben
authors: T
authors: Glatz
authors: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors: Goran
authors: G
authors: Marjanovic
authors: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors: Birte
authors: B
authors: Kulemann
authors: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors: Julian
authors: J
authors: Hipp
authors: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors: Ulrich
authors: U
authors: Theodor Hopt
authors: Division of Interdisciplinary Endoscopy, Department of Internal Medicine II, University of Freiburg, Freiburg, Germany.
authors: Andreas
authors: A
authors: Fischer
authors: Division of Interdisciplinary Endoscopy, Department of Internal Medicine II, University of Freiburg, Freiburg, Germany.
authors: Hans-Jürgen
authors: HJ
authors: Richter-Schrag
authors: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors: Jens
authors: J
authors: Hoeppner
mesh_terms: D000368:Aged; D016208:Databases, Factual; D004935:Esophageal Diseases / Q000401:mortality / Q000601:surgery*; D004945:Esophagoscopy / Q000295:instrumentation* / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000401:mortality / Q000601:surgery; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
keywords: Boerhaave's syndrome; esophageal perforation; esophageal reconstruction; esophageal rupture; esophageal stents