Treatment of oesophageal perforations and its complications (Mediastinitis, abscess) with covered metal stent and drainage

Abstract

Introduction: The covered metal stents were first used for malignant oesophageal stenosis. Since 2007 we have used it 15 times for treatment of oesophageal perforations and post-operative leaks. Methods and patients: When the perforation or leakage was recognised the decision on the ways of therapy was done after consultation with an oesophageal surgeon. The optimal size of retrievable covered metal stent was calculated individually. The stenting was supplemented in most cases with drainage, and with antibiotic treatment in an intensive care unit. The timing of stent removal (in most cases 6 – 10 weeks) was after individual consideration. The indications for stenting were: iatrogenic perforation in corrosive stenosis in 4 cases; Boerhaave's syndrome in 2 cases; postoperative leakage in 6 cases; oesophagus defect after thyroid surgery in 1 case and thoracic empyema with oesophageal fistula in 2 cases. Results: The oesophageal defect was sailed in all 15 cases. One patient died as a result of a non-related disease – severe lung destruction and aspergillosis. Twelve oesophagus defects were healed from 14 patients. In one case, with operated Boerhaave's syndrome, the inveterate fistula persisted. In another case, the septic patient with Boerhaave's syndrome was treated with drains and late stenting. After medical stabilization two (residual) mediastinal abscesses were left; they were not drained by the referring hospital despite our request. After removing the stent we observed 2 fistulae. After subtotal oesophagectomy substernal a gastric tube bypass was performed. Conclusion: Early stenting and drainage is a safe, effective and less invasive treatment of oesophageal perforation and leakage with low mortality.