Esophageal stenting for spontaneous esophageal perforation

Abstract

Stenting has proven to be a promising treatment of spontaneous esophageal perforation, but currently, the scientific background to treatment of this condition is limited. Fourteen consecutive patients with spontaneous esophageal perforation were treated with coated self-expandable stent and a debridement procedure (three patients by thoracotomy, four by thoracoscopy, three by tube drainage, and two patients with no drainage). Eight patients had one stent, while six patients needed one or more additional stents to achieve source control. Patients were treated for a mean period of 9 days in the intensive care unit. Patients who had definitive source control with primary stent were treated for a mean of 3 days in the intensive care unit, while those who needed more stents were treated for a mean of 15 days (p = 0.009). Two patients (14%) died during the in-hospital stay, both of them having received more than one stent. Eight patients had one stent, while six patients needed one or more additional stents to achieve source control. The mean estimated time from rupture to stenting was 58 hours (median, 27 hours). Fourteen percent of patients who underwent stenting within 24 hours to stent placement were in septic shock compared with 86% of patients with a delay of more than 24 hours. Stent placement with thoracic debridement seems to be effective as a primary treatment of spontaneous esophageal perforation. According to our findings, it is of utmost importance to achieve source control with the first stent. Additional debridement procedures are still invariably needed. Therapeutic study, level IV.