Short-term esophageal stenting in the management of benign perforations

Am J Gastroenterol. 2010 Jul;105(7):1515-20. doi: 10.1038/ajg.2010.104. Epub 2010 Mar 16.

Abstract

Objectives: The standard approach to benign esophageal perforations consists of conservative treatment or surgery. In this study, we investigated the efficacy of short-term stent placement for nonmalignant esophageal perforations.

Methods: This is a prospective single-center study of patients with benign esophageal perforations in whom a removable self-expandable stent was placed. Data were collected from a prospective database, endoscopy records, and operation reports. To obtain follow-up data, we contacted the patients, their relatives, or their general practitioner.

Results: A total of 33 patients underwent stent insertion owing to an iatrogenic perforation (n=19), Boerhaave's syndrome (n=10), or other causes (n=4); this resulted in an immediate and complete sealing of the lesion in 32 patients (97%). Stents migrated in 11 patients (33%). Four patients required an esophageal resection for failed stent therapy (n=3) and failed stent removal (n=1). The 90-day mortality rate was 15%. A total of 33 endoscopic stent extractions were attempted. Overall, 23 stents were extracted within 6 weeks (group I) and 10 stents between 6 and 84 weeks (group II). Extractions were uncomplicated in all patients in group I (100%) vs. in 5 patients in group II (50%) (P=0.001). Six extraction-related complications occurred in group II, including two self-limiting bleedings, three stent fractures, and one impacted stent.

Conclusions: In patients with a benign esophageal perforation, temporary stent therapy is effective and provides a good alternative to surgery. Complications due to stent removal can be prevented by removal of the prosthesis within 6 weeks after insertion, without compromising the efficacy of treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Device Removal
  • Esophageal Perforation / etiology
  • Esophageal Perforation / mortality
  • Esophageal Perforation / therapy*
  • Esophagoscopy
  • Female
  • Fluoroscopy
  • Foreign-Body Migration / epidemiology
  • Humans
  • Iatrogenic Disease
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Proportional Hazards Models
  • Prospective Studies
  • Stents*
  • Survival Rate
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome