title: Endoscopic Management of Esophageal Perforations: Who, When, and How?
abstract: Esophageal perforations can be spontaneous or iatrogenic. Although they are a rare occurrence, they are associated with a significant morbidity and mortality. Traditionally, management of esophageal perforation consisted of surgery. However, endoscopic management is now emerging as the primary treatment modality and is less invasive and morbid than surgery. Endoscopic modalities include through-the-scope clips (TTS), over-the-scope clips (OTSC), placement of covered stents, and suturing. Suturing can be used for primary closure of the perforation as well as anchoring of stents to prevent migration. Smaller defects (<2 cm) can be closed with clips (TTS or OTSC), whereas larger defects require a stent placement or suturing to achieve closure. If the perforation is associated with a mediastinal collection, drainage is mandatory and can be done via CT-guided percutaneous drainage, surgery, or endoscopic vacuum therapy.
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, Australia.|Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1800 Orleans St, Suite 7125B, Baltimore, MD, 21205, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Saxena
authors.affiliation: Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1800 Orleans St, Suite 7125B, Baltimore, MD, 21205, USA. mkhasha1@jhmi.edu.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
keywords: Endoscopic management; Endoscopic perforation; Esophageal; Perforation; SEMS