496. OESOPHAGEAL STENTING IN BOERHAAVE SYNDROME: OUR EXPERIENCE

Abstract

Abstract Introduction Boerhaave syndrome is the spontaneous rupture of the oesophagus. This rare condition is associated with a high mortality. Its treatment remains controversial, with an aggressive surgical approach being most described. In striving for the safest and most minimally invasive treatment for our patients, we opt for a multidisciplinary intervention: prompt endoscopic stenting of the esophageal defect in combination with optimal drainage of the pleural cavities. We reviewed our recent experience. Methods In our referral hospital, between October 2018 and October 2023, we treated nine patients with Boerhaave syndrome by prompt endoscopic stenting of the esophageal defect combined with drainage of either one or both pleural cavities, preferentially by thoracoscopy. Retrospectively the data from these patients was analysed to provide an overview of our experience with this multidisciplinary approach. Results In total we have treated six men and three women with a median age of 61 years (53-82years). All patients received an endoscopy and pleural catheter drainage at presentation, combined with stenting of the 1-4cm esophageal defect. In six patients (67%) the minimally invasive treatment was successful, with a median hospitalisation period of 33 days (17-77days) and median stent removal after 47 days (40-73days). All these patients reported a good oral intake. Thoracoscopic debridement of the pleural cavity was performed in seven patients. In one patient endoscopic stenting failed with the need for an oesophagostomy. Two patients have deceased, resulting in 22% overall mortality. Conclusion Boerhaave syndrome is known to be a surgical emergency. From our experience we conclude that prompt endoscopic stenting of the oesophageal defect in combination with drainage of the pleural cavities is a safe and minimal invasive approach, even for cases with larger defects and extensive contamination of the thorax. Due to the rarity of the condition, data is limited. We advocate for a registration study to obtain the current golden standard.