Esophageal Perforation Research Articles

Preventing battery ingestion in children: public health strategies and technological innovations

Abstract Background Accidental ingestion of button batteries can cause severe and sometimes fatal injuries, such as chemical burns, esophageal perforations, and long-term complications. In response to this challenge, prevention strategies have evolved. A recent example of safety-targeted technological innovation includes new coin lithium batteries with more secure packaging, a non-toxic bitter coating to deter ingestion, and a ‘color alert technology’ that activates a blue dye upon contact with saliva. These features are designed to discourage ingestion and facilitate the rapid identification of an injury, allowing for timely medical intervention. Methods This abstract reviews the public health strategies proposed or implemented to prevent this serious type of injury, augmented by an analysis of data from the Susy Safe registry, which identified 1,115 cases of battery ingestion in children, and an additional 94 cases from the literature, totaling 1,209 injuries. Results The review of existing prevention strategies highlights various approaches, including public awareness campaigns, enhanced product regulations, and the implementation of stricter safety standards for batteries and devices. Analysis of Susy Safe data helps characterize the issue, underscoring the frequency and circumstances of battery ingestions and provides an empirical basis to assess the effectiveness of existing prevention strategies and to guide the development of new policies. The combination of technological improvements and legislative initiatives could represent a significant breakthrough in preventing these dangerous injuries. Conclusions While technological innovations are promising, effective prevention of battery ingestion will require a multifaceted approach that integrates technology, education, public policy, and regulatory oversight. Collaboration among manufacturers, lawmakers, health professionals, and the community is essential to reduce the incidence of these medical emergencies. Key messages • Accidental ingestion of button batteries can cause severe and sometimes fatal injuries. • The combination of technological improvements and legislative initiatives could represent a significant breakthrough in preventing button batteries in children.

Decortication with uniport video-assisted thoracoscopic surgery for empyema due to postoperative esophageal leakage: a report of two pediatric cases

BackgroundVideo-assisted thoracoscopic surgery (VATS) is considered useful for the treatment of parapneumonic empyema in children. However, thoracoscopic management of empyema due to esophageal leakage as an operative complication has not been well described in the literature.Case presentationWe successfully decorticated severe empyema using uniport VATS in 2 children (a 2-year-old boy who suffered esophageal perforation after laparoscopic anti-reflux surgery, and a 7-month-old girl who had anastomotic leakage after thoracoscopic repair of esophageal atresia). In these patients, we noticed that pleural effusion rapidly progressed to empyema and caused respiratory insufficiency due to wide-range coverage by fibrotic pleural rind that was successfully decorticated under video-assisted vision from a mini-thoracotomy, followed by spontaneous healing of the leakage.ConclusionsWe did not attempt to closely approach or try to repair the esophageal leakage. We believe that this is an important tip for these situations.

Esophageal perforation and epidural emphysema as complications of nasogastric tube placement

Esophageal perforation and epidural emphysema as complications of nasogastric tube placement

Consideration of Antifungal Coverage in Treating Infections Related to Delayed Esophageal Perforation from Anterior Cervical Spine Hardware

(1) Background/Objectives: Delayed esophageal perforation following anterior cervical (spine) discectomy and fusion (ACDF) is rare but can lead to serious infectious complications. The treatment usually involves hardware explanation and prolonged intravenous antibiotics; however, there are scarce reports about the microbiology of these infections and corresponding targeted therapy. (2) Methods: Patients diagnosed or treated for delayed esophageal perforation after anterior cervical fusion between 2000–2020 at a tertiary medical center were studied. (3) Results: Seven patients with delayed esophageal perforation following ACDF were identified. The most common bacteria isolated included Streptococcus, Haemophilus, and Mycobacterium species. The cultures from five patients grew fungal species, including Candida albicans and C. glabrata. All the patients received several weeks of broad-spectrum antibiotics, and, notably, 5/7 patients received antifungal therapy targeting Candida. (4) Conclusions: Although the incidence of delayed esophageal perforation following ACDF is low, providers should remain aware of this entity due to the serious infectious complications. Most infections are polymicrobial in nature, and providers should consider empiric antifungal coverage specifically targeting Candida species when treating patients with this complication.

Spontaneous Oesophageal Perforation treated with Oesophageal Stent

Spontaneous Oesophageal Perforation treated with Oesophageal Stent

Esophageal Perforation in Premature Newborns

Introduction. Esophageal perforation is a rare entity in newborns. This condition is most common in premature babies with very low and extremely low birth weight. The major cause of such pathology is considered to be iatrogenic trauma of either pharynx or esophagus, their soft tissues being delicate and tender enough to produce delamination and perforation of their wall. As a rule, this occurs as a complication of either a difficult tracheal intubation soon after birth or during some troubles with oro-/ nasogastric tube insertion. Materials and methods. During 2017 - 2022 9 newborns with esophageal perforation were treated at Childrens’ City center of neonatal surgery of St-Petersburg. All of them were premature, 2 having very low, and 7 having extremely low birth weight. The incidence of that condition appeared to be 1:1320 live births. Results and discussion. 8 from 9 patients were treated conservatively. This included adjustment of artificial lung ventilation, pain control, antibiotics, cancellation of gastric enteral feeding and administration of total parenteral nutrition. Thoraco- or laparocentesis was performed when needed (in cause of hydrothorax, pneumothorax or ascites). 2 patients died, both being born at 23th week of gestation. In both cases death occurred from polyorganic insufficiency. The mortality rate appeared to be 22 %. Conclusions. In most cases the esophageal perforation in premature babies can be treated conservatively, the efficacy of such treatment being largely dependent on early diagnosis of this complication. An important key-point in it is a radiologic control of gastric tube location.

Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis.

Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a metanalysis of the available data on the clinical success rate of EVAC. Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes. In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively. This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

Clinical evaluation of oxaliplatin-loaded drug-eluting callispheres beads transarterial chemoembolization for unresectable or recurrent esophageal carcinoma

BackgroundA majority of esophageal carcinoma patients are diagnosed at an advanced stage and are no longer suitable for surgical resection. Drug-eluting beads transarterial chemoembolization (DEB-TACE) with oxaliplatin-loaded CalliSpheres beads (CB) have been used for advanced hepatocellular carcinoma and lung cancer, but they have not been reported for the treatment of unresectable or recurrent esophageal carcinoma.MethodsDEB-TACE was performed on 22 patients with unresectable or recurrent esophageal carcinoma between March 2019 and May 2022. The clinical outcomes, complications, and efficacy were retrospectively recorded and analyzed.ResultsA total of 39 sessions of DEB-TACE were performed in 22 patients, with a technical success rate of 92.3% and clinical success rate of 65.0%. No severe complications such as procedure-related death, esophageal rupture or paraplegia were observed. Complete response, partial response, and stable disease were observed in 14.3% (2/14), 42.9% (6/14), and 21.4% (3/14) of patients 6 months after DEB-TACE, respectively. The objective response rates were 62.5%, 42.9% and 57.1% respectively at 1-, 3-, and 6-month after DEB-TACE. Subsequent interventional treatments were administered to 12 patients, including DEB-TACE for hepatic metastasis in 3 (13.6%), esophageal stenting in 5 (22.7%), and airway stent placement in 5 (22.7%). Two patients were lost to follow up. A total of 9 patients died due to tumor progression (n = 5), pneumatic infection (n = 1), and tumor-related massive esophageal hemorrhage (n = 3). The median overall survivals were 13.9 months and 26.5 months from the first session of DEB-TACE and the diagnosis of esophageal carcinoma, respectively.ConclusionsDEB-TACE with oxaliplatin-loaded CB is suggested as a safe and effective treatment of unresectable or recurrent esophageal carcinoma, and more studies are required to confirm its efficacy and safety.

Self-expanding metal stent for relieving the stricture after endoscopic injection for esophageal varices.

Esophageal stricture is one of the complications after esophageal varices sclerotherapy injection (ESI), and the incidence rate is between 2%-10%. To explore the efficacy of self-expanding metal stent (SEMS) for the stricture after endoscopic injection with cyanoacrylate (CYA) and sclerotherapy for esophageal varices. We retrospectively analyzed the efficacy of SEMS to improve the stricture after endoscopic injection with CYA and sclerotherapy for esophageal varices in 4 patients from February 2023 to June 2023. The strictures were improved in four patients after stenting. The stent was removed after two weeks because of chest pain with embedding into esophageal mucosa in one patient. The stent was removed after one month, however, the stent was reinserted because of the strictures happening again in two patients. The stent was removed after three months, however, the stent was reinserted because of the strictures happening again in one patient. The stent embedded into esophageal mucosa in three patients. There were 3 patients suffered reflux esophagitis, and the acid reflux was relieved by taking hydrotalcite. There was no other complication of esophageal perforation, bleeding from varices or infection. SEMS may relieve the stricture which happened after endoscopic injection with CYA and sclerotherapy for esophageal varices. However, when we should remove the stent still needs to be explored.

S4152 Successful Endoscopic Management of Near-Fatal Boerhaave's Syndrome in High-Risk Non-operative Patient

S4152 Successful Endoscopic Management of Near-Fatal Boerhaave's Syndrome in High-Risk Non-operative Patient

Clinical outcomes of drug-coated balloons dilatation for benign esophageal stricture

BackgroundDrug-coated balloons (DCBs) angioplasty is safe and effective for coronary artery disease. However, DCBs dilatation for the treatment of benign esophageal strictures is rarely reported.PurposeWe aimed to report the clinical outcomes of DCBs dilatation for patients with benign esophageal strictures.MethodsFrom May 2020 to August 2023, 18 patients underwent DCBs dilatation for benign esophageal strictures. Baseline demographics were recorded and evaluated, including gender, age, comorbidities, stricture diameter and length, dilatation session, complications.ResultsA total of 24 dilatation sessions of DCBs were performed, with a mean of 1.3 ± 0.6 sessions per patients (range 1.0–5.0). Dysphagia score decreased significantly after DCBs dilatation (2.6 ± 1.1 vs. 0.9 ± 1.3, p = 0.0002). Both stricture diameter and stricture index decreased significantly after DCBs dilatation (p < 0.0001). No procedure-related death, massive bleeding or esophageal perforation was observed during or after DCBs dilatation. Minor complications were found in only 3 patients (16.7%). All 18 patients were successfully followed up for a median period of 12.0 months. By the end of follow up, 10 patients showed no dysphagia, 6 patients showed mild dysphagia and 2 patients showed no improvement in dysphagia. The clinical success rate of DCBs dilatation is 88.9%.ConclusionDCBs dilatation may be a safe, effective and feasible treatment for benign esophageal strictures, and can be utilized as an alternative option after standard dilatation has failed. Prospective studies with large samples are needed to further validate its clinical efficacy.

Development and Implementation of a Multicenter Registry for Resuscitation-Focused Transesophageal Echocardiography

To evaluate the clinical effect, safety, and clinical outcomes of focused transesophageal echocardiography (TEE) in the evaluation of critically ill patients in the emergency department (ED) and ICUs. We established a prospective, multicenter, observational registry involving adult critically ill patients in whom focused TEE was performed for evaluation of out-of-hospital cardiac arrest (OHCA), inhospital cardiac arrest, evaluation of undifferentiated shock, hemodynamic monitoring, and/or procedural guidance in the ED, ICU, or operating room setting. The primary objective of the current investigation was to evaluate the clinical influence and safety of focused, point-of-care TEE in critically ill patients. Data elements included patient and procedure characteristics, laboratory values, timing of interventions, clinical outcomes, and TEE video images. A total of 1,045 focused TEE studies were collected among 916 patients from 28 hospitals, including 585 (64%) intraarrest and postarrest OHCA and inhospital cardiac arrest, 267 (29%) initial evaluation of undifferentiated shock, 101 (11%) procedural guidance, and 92 (10%) hemodynamic monitoring. TEE changed management in 85% of patients with undifferentiated shock, 71% of patients with inhospital cardiac arrest, and 62% of patients with OHCA. There were no reported esophageal perforations or oropharyngeal injuries, and other procedural complications were rare. A prospective, multicenter, and multidisciplinary TEE registry was successfully implemented, and demonstrated that focused TEE is safe and clinically impactful across multiple critical care applications. Further studies from this research network will accelerate the development of outcome-oriented research and knowledge translation on the use of TEE in emergency and critical care settings.

S3988 Esophageal Perforation After Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement: A Complication Treated Successfully With Endoscopic Stent and Suture

S3988 Esophageal Perforation After Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement: A Complication Treated Successfully With Endoscopic Stent and Suture

S682 Esophageal Foreign Body Impaction Followed by Immediate Dilation Is Not Associated With an Increased Risk of Esophageal Perforation: A Systematic Review With Meta-Analysis

S682 Esophageal Foreign Body Impaction Followed by Immediate Dilation Is Not Associated With an Increased Risk of Esophageal Perforation: A Systematic Review With Meta-Analysis

S3305 Esophageal Perforation Resulting From Nonaccidental Trauma in a Neonate

S3305 Esophageal Perforation Resulting From Nonaccidental Trauma in a Neonate

S4057 Endoscopic Vacuum Therapy for the Management of Atrial Fibrillation-Induced Esophageal Perforation

S4057 Endoscopic Vacuum Therapy for the Management of Atrial Fibrillation-Induced Esophageal Perforation

S3214 Novel Method of Treating a Malignant Esophageal Perforation via Endoscopic Vacuum Assisted Wound Closure (EVAC) by Overtube

S3214 Novel Method of Treating a Malignant Esophageal Perforation via Endoscopic Vacuum Assisted Wound Closure (EVAC) by Overtube

Clinical study on diverse surgical affections of oesophagus in buffaloes

This Article presents the detailed study of oesophageal affections of buffaloes recorded in the clinic of Department of Veterinary Surgery and Radiology VCC CVAS, RAJUVAS, Bikaner Rajasthan India. Different clinical symptoms, types of affections, etiology and postoperative complications were recorded, plane and contrast radiographic study was carried out and affections were categorized based on their diagnosis. Complete obstruction was present in the highest number followed by diverticulum. The site of obstruction in most of the animal was distal cervical regional close to the thoracic inlet and impacted plastic and tarpaulin was the most impacted material retrieved in the oesophagotomy procedures. Conservative and surgico-therapeutic treatment was carried out. Rupture of oesophagus was noticed as a consequence of complete obstruction at proximal site in delayed presented cases. Narrowing of oesophagus noticed at mid cervical region because of the fibrosis of the oesophgaus. Dilation of oesophagus was present in consequences of chronic obstruction and chronic history of ailments. Penetrating foreign bodies mostly sharp needles were present at proximal oesophagus. Early presented cases having healthy mucosa showed the successful outcome and chronicity of the condition resultant in complications and poor prognosis.

High Blood Ammonia Level Is a Predictor of Medium and Large Size Esophageal Varices In Cirrhotic Patients

Background: The development of esophageal varices (EV) and rupture of them are the most serious complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV but it is a costly and troublesome invasive procedure. To find a non-invasive method for detection of size of EV and to predict the bleeding risk is appealing and would decrease the indications cost and discomfort of upper GI endoscopy. The aim of the study is to evaluate high blood ammonia level is a predictor of medium and large size of esophageal varices in Cirrhotic patients. Methods: This was an observational Cross-sectional study conducted on 40 cirrhotic patients in Department of Gastroenterology, BSMMU using a pre-designed data collection sheet. Information about clinical profile, laboratory parameters- blood ammonia, serum bilirubin, serum albumin, prothrombin time, and ultrasonography of abdomen, endoscopy upper GIT was collected and recorded. The collected data was analyzed by computer with the help of SPSS version 22. Statistical analysis was done by using appropriate statistical tool like Chi-square test, Student’s t- test. P value &lt; 0.05 was considered as significant. Diagnostic efficacy of blood ammonia was calculated by using a value. Results: A total of 40 patients with cirrhosis. Mean age of cirrhotic patients were 47.47±12.98 years. Mean blood ammonia of small size EV of cirrhotic patients was 73.70±32.11 (μmol/L) and medium and large size EV was 118.3±38.37 (μmol/L) (P&lt; .001). At the level of 78.5 (μmol/L), sensitivity and specificity of blood ammonia was 95% and 65% respectively in detection of size of EV. Conclusion: Blood ammonia estimation could be a good tool for identifying individuals with medium and large size esophageal who will need to undergo endoscopy more frequently. Bangladesh J Medicine 2024; 35: 167-172

Endoscopic management of Boerhaave syndrome: a comprehensive review of techniques, outcomes and future directions

Boerhaave syndrome, characterized by spontaneous esophageal rupture, presents a critical condition requiring prompt diagnosis and intervention to reduce morbidity and mortality. Traditionally managed with surgical intervention, advancements in endoscopic techniques have emerged as viable alternatives, offering less invasive options with promising outcomes. This article provides a thorough review of the endoscopic management of Boerhaave syndrome, detailing the indications, techniques, and outcomes associated with various endoscopic approaches. We examine the role of esophageal stenting, clipping, and tissue sealants, alongside adjunctive therapies. Furthermore, we discuss patient selection criteria, procedural considerations, and potential complications. Our review highlights the evolving landscape of Boerhaave syndrome management, underscoring the importance of multidisciplinary collaboration and the need for further research to optimize patient outcomes.