Expandable stents for iatrogenic perforation of esophageal malignancies

J Gastrointest Surg. Sep-Oct 2003;7(6):715-9; discussion 719-20. doi: 10.1016/s1091-255x(03)00064-7.

Abstract

The management of patients with iatrogenic perforation of esophageal cancers is controversial. We reviewed the management of perforated esophageal malignancies at a single institution with a large volume of patients with esophageal cancer. Cases of iatrogenic perforation of the esophagus occurring during a 3-year period were identified from the hospital endoscopy database. Inpatient and outpatient records were reviewed, and subjects were visited to obtain follow-up information. Perforation was suspected after 10 of 492 endoscopic dilatation procedures done in patients with obstructing esophageal malignancies. All patients were diagnosed immediately. One patient with pneumomediastinum and pneumoperitoneum died 7 days after laparotomy. Nine patients with pneumomediastinum were managed endoscopically with delayed (n=1) or immediate (n=8) placement of a self-expanding metal stent. Patients were treated in the hospital for an average of 5.4 days. No patients developed clinical signs of sepsis, and all were discharged tolerating a soft diet. Follow-up data were obtained for seven of nine discharged patients (range 152 to 263 days). None developed signs or symptoms of infection or recurrent dysphagia. Immediate placement of a coated self-expanding metal stent is an effective treatment for iatrogenic perforation of an obstructing esophageal malignancy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Dilatation / adverse effects
  • Endoscopy
  • Esophageal Neoplasms / surgery*
  • Esophageal Perforation / surgery*
  • Female
  • Humans
  • Iatrogenic Disease*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents*
  • Treatment Outcome