Esophagobronchial Fistula Research Articles

Corrigendum to ‘‘Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report”

Corrigendum to ‘‘Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report”

Protocolo diagnóstico y terapéutico de la ingesta de cáusticos

The ingestion of caustic agents is a medical emergency due to the serious injuries they can cause to the upper digestive tract. It is estimated to have a frequency of 38.7 cases/100,000 inhabitants and a mortality rate of 1%–4% in Western countries. There are two typical scenarios: accidental ingestion, of small quantity and with a more benign course, and ingestion with the purpose of self-harm, of larger quantity and with a worse prognosis. The initial management consists of ensuring hemodynamic stability and airway permeability, avoiding actions such as inducing vomiting or the use of neutralizing substances. Radiological tests together with endoscopy allow for assessing severity and stratifying the risk of complications. Treatment varies according to the Zargar classification, ranging from outpatient management to emergency surgery in cases of perforation. Long-term follow-up allows for the detection of complications such as esophageal stricture, esophagobronchial fistulas, and esophageal cancer.

Utility of Infrared Technology in Minimally Invasive Procedures: A Novel Strategy to Identify a Esophagobronchial Fistula via Thoracoscopy

Esophagobronchial or esophagopulmonary fistulas are complications after esophageal atresia/tracheoesophageal fistula (EA/TEF) repair. Postoperative scarring and recurrent infections render surgical treatment a potentially hazardous undertaking.This report describes the use of infrared (IR) technology to locate and safely dissect a esophagobronchial fistula in a 11-year-old female with a history of EA/TEF. The patient, who had initially undergone primary repair via thoracotomy, was diagnosed with a late tracheoesophageal fistula (TEF) recurrence at the age of 6 after several pulmonary infections and was subjected to a left thoracoscopy with successful closure of the TEF. Despite both surgical procedures, she presented ongoing respiratory symptoms for several years and was referred to our center as an 11-year-old, where further examinations revealed the presence of a esophagobronchial fistula involving the right upper bronchus. After an unsuccessful attempt at endoscopic closure, surgical treatment via right thoracoscopy was planned. Initially, an endoscopic examination was performed, to catheterize the fistula tract in the mid-thoracic esophagus with the infrared probe. Subsequently, right thoracoscopy was performed in the prone position using four 5 mm trocars. Guided by the IR signal, the fistula tract was easily identified and dissected. Fistula closure was achieved using a 5 mm stapler. The staple line was reinforced with a pleural flap and a right thoracic tube was inserted. The patient was discharged after a four-day hospital stay, without complications. The patient remains asymptomatic to date and has returned to her native Ukraine.

A missense variant at the RAC1-PAK1 binding site of RAC1 inactivates downstream signaling in VACTERL association

RAC1 at 7p22.1 encodes a RAC family small GTPase that regulates actin cytoskeleton organization and intracellular signaling pathways. Pathogenic RAC1 variants result in developmental delay and multiple anomalies. Here, exome sequencing identified a rare de novo RAC1 variant [NM_018890.4:c.118T > C p.(Tyr40His)] in a male patient. Fetal ultrasonography indicated the patient to have multiple anomalies, including persistent left superior vena cava, total anomalous pulmonary venous return, esophageal atresia, scoliosis, and right-hand polydactyly. After birth, craniofacial dysmorphism and esophagobronchial fistula were confirmed and VACTERL association was suspected. One day after birth, the patient died of respiratory failure caused by tracheal aplasia type III. The molecular mechanisms of pathogenic RAC1 variants remain largely unclear; therefore, we biochemically examined the pathophysiological significance of RAC1-p.Tyr40His by focusing on the best characterized downstream effector of RAC1, PAK1, which activates Hedgehog signaling. RAC1-p.Tyr40His interacted minimally with PAK1, and did not enable PAK1 activation. Variants in the RAC1 Switch II region consistently activate downstream signals, whereas the p.Tyr40His variant at the RAC1-PAK1 binding site and adjacent to the Switch I region may deactivate the signals. It is important to accumulate data from individuals with different RAC1 variants to gain a full understanding of their varied clinical presentations.

Thoracoscopic esophageal drainage for tracheal compression due to mucocele after esophagogastric bypass: a case report

BackgroundEsophagogastric bypass is performed for esophageal strictures. Mucus retention, known as mucocele, sometimes occurs at the stricture oral side of the remnant esophagus. It is often asymptomatic and is expected to be naturally decompressed, but it may cause respiratory failure depending on the case. Herein, we report a case in which we successfully performed thoracoscopic esophageal drainage as emergency airway management due to tracheal compression by a mucocele after esophagogastric bypass for unresectable esophageal cancer with esophagobronchial fistula.Case presentationA 56-year-old man underwent esophageal bypass surgery for an unresectable esophageal carcinoma with an esophagobronchial fistula following chemotherapy and radiation therapy. Nine months after bypass surgery, he experienced severe dyspnea due to tracheal compression caused by mucus retention on the oral side of the esophageal tumor. We planned thoracoscopic surgery for mucus retention drainage through the right thoracic cavity to secure the airway as an emergency procedure under general anesthesia. Intubation can be performed safely by guiding bronchoscopy in the semi-supine position. Upper esophageal dilation was observed on the cranial side of the azygos arch. We dissected the mediastinal pleura of the upper thoracic esophagus and exposed its wall. A 12-Fr silicone drain was placed in the esophagus through the right chest wall and 120 ml of white fluid was aspirated. He was discharged 9 days after surgery without complications and resumed treatment with an immune checkpoint inhibitor 23 days after surgery. Thereafter, he continued chemotherapy for esophageal cancer, but died of tumor progression and lung metastasis 35 months after bypass surgery and 25 months after thoracoscopic surgery.ConclusionsThoracoscopic esophageal drainage could be performed safely as emergency airway management, shorten the period of discontinuance, and allow cancer treatment to be resumed promptly. We believe that this thoracoscopic procedure is an effective and less invasive method if the percutaneous approach is difficult.

Management of anastomotic leakage after robot-assisted minimally invasive esophagectomy with an intrathoracic anastomosis.

Anastomotic leakage is a feared complication after esophagectomy and associated with increased post-operative morbidity and mrotality. The aim of this study was to evaluate the management of leakage after robot-assisted minimally invasive esophagectomy (RAMIE) with intrathoracic anastomosis. From a single center prospectively maintained database, all patients with anastomotic leakages defined by the Esophageal Complications Consensus Group between 2016 and 2021 were included. Contained leakage was defined as presence of air or fluid at level of the anastomosis without the involvement of the mediastinum or thorax. Non-contained leakage was defined as mediastinitis and/or mediastinal/pleural fluid collections. The primary outcome was 90-day mortality and the secondary outcome was successful recovery. In this study, 40 patients with anastomotic leakage were included. The 90-day mortality rate was 3% (n = 1). Leakage was considered contained in 29 patients (73%) and non-contained in 11 patients (27%). In the contained group, the majority of the patients were treated non-surgically (n = 27, 93%) and management was successful in 22 patients (76%). In the non-contained group, all patients required a reoperation with thoracic drainage and management was successful in seven patients (64%). Management failed in 11 patients (28%) of whom 7 developed an esophagobronchial fistula, 3 had a disconnection of the anastomosis and 1 died of a septic bleeding. In conclusion, this study demonstrates that the management anastomotic leakage in patients who underwent RAMIE with an intrathoracic anastomosis was successful in 73% of the patients with a 90-day mortality rate of 3%. A differentiated approach for the management of intrathoracic anastomotic leakage is proposed.

S2304 Esophagobronchial Fistula After a Laparoscopic Partial Fundoplication, Mimicking as Empyema

S2304 Esophagobronchial Fistula After a Laparoscopic Partial Fundoplication, Mimicking as Empyema

Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition characterized by outpouchings from the esophageal lumen into the outer esophageal wall. It can lead to complications such as esophageal strictures presenting as dysphagia and esophagobronchial fistula (EBF) presenting as recurrent aspiration pneumonia. Only 1 other report of EIP with EBF has been reported in the literature. EIP itself is typically managed medically while a complication such as EBF, on the other hand, elicits far more invasive approaches in the form of open surgical intervention. We present the case of a 50 year-old male newly diagnosed with EIP complicated by EBF who was palliated with esophageal stenting. Upper endoscopy with esophageal stent placement offers a safe, feasible, and non-operative therapy for EIP and EBF.

Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review

BackgroundThe development of esophago-bronchial fistula after esophagectomy and reconstruction using a posterior mediastinal gastric tube remains a rare complication associated with a high rate of mortality.Case presentationA 63-year-old man with esophageal cancer underwent a thoracoscopic esophagectomy with two-field lymph node dissection and reconstruction via a gastric tube through the posterior mediastinal route. Postoperatively, the patient developed extensive pyothorax in the right lung due to port site bleeding and hematoma infection. Four months after surgery, he developed an esophago-left bronchial fistula due to ischemia of the cervical esophagus and severe reflux esophagitis at the site of the anastomosis. Because of respiratory failure due to the esophago-bronchial fistula and the history of extensive right pyothorax, right thoracotomy and left one-lung ventilation were thought to be impossible, so we decided to perform the surgery in three-step systematically. First, we inserted a decompression catheter and feeding tube into the gastric tube as a gastrostomy and expected neovascularization to develop from the wall of the gastric tube through the anastomosis after this procedure. Second, 14 months after esophagectomy, we constructed an esophagostomy after confirming blood flow in the distal side of the cervical esophagus via gastric tube using intraoperative indocyanine green-guided blood flow evaluation. In the final step, we closed the esophagostomy and performed a cervical esophago-jejunal anastomosis to restore esophageal continuity using a pedicle jejunum in a Roux-en-Y anastomosis via a subcutaneous route.ConclusionThis three-step operation can be an effective procedure for patients with esophago-left bronchial fistula after esophagectomy, especially those with respiratory failure and difficulty in undergoing right thoracotomy with left one-lung ventilation.

Endoluminal Vacuum Therapy for Definitive Management of an Esophagobronchial Fistula

PurposeEndoluminal vacuum (EVAC) therapy has gained popularity as a minimally invasive option for contained esophageal leaks. EVAC therapy may be useful for esophagogastric anastomotic leak fistulizing to the airway. DescriptionThis report describes EVAC therapy of an esophagobronchial fistula with video depicting the procedure, including technical tips. Video and photographic evidence of progression and ultimate resolution is included. EvaluationSponge exchanges were completed every 3 to 4 days. EVAC therapy was administered through a transnasal approach. In the presented case, a total of 11 exchanges over 6 weeks were required. EVAC sponge placement was transitioned from intracavitary to endoluminal for the final 4 treatments. All but 4 exchanges were able to be completed at the bedside in a monitored setting with sedation. ConclusionsAn esophageal leak that has fistulized to a main airway is a rare and challenging clinical problem. Definitive EVAC therapy for esophageal anastomotic leak with esophagobronchial fistula is a feasible option in selected cases.

An Infectious Cause of Esophagobronchial Fistula

An infected cause of esophagobronchial fistula between left bronchus and esophagus is mentioned who is a 32 year old male with a history of smoking and I/V drug abuse. The scientific reasons for suspecting an esophagogastric-bronchial fistula in an adult are discussed, as well as a description of the different etiologies of this condition. Intra thoracic malignancy, injuries, and infections are the most frequent causes of esophageal-bronchial fistula. These fistulas are caused by the rupturing of caseous peribronchial lymph nodes into adjacent structures such as the esophagus and bronchi. It's difficult to determine what the right course of action is. Such cases are surgically treated, while others can only be treated conservatively. Diagnosing bronchoesophageal fisula is usually challenging and often delayed, since there have not been many cases found. Any patient who presents with cough after deglutition should be suspected of having an esophagobronchial fistula, and tubercular origin should also be considered, particularly in an endemic region, since early diagnosis and treatment with anti-tubercular therapy typically results in resolution.

Esophagotracheal and esophagobronchial fistulas

Esophagobronchial and esophagotracheal fistulas are rare but complex diseases with aheterogeneous spectrum of underlying etiologies. Common causes are locally advanced tumors of the esophagus and larynx, traumatic perforation from the esophageal or tracheal side as well as postoperative fistulas. The management of esophagotracheal and esophagobronchial fistulas always involves different health care providers and in most cases patients require amultidisciplinary treatment on the intensive care unit. The therapeutic concept primarily depends on the underlying cause, localization and size of the fistula but decision making is also influenced by the severity of the course of sepsis and the extent of the respiratory dysfunction. Endoscopic management with esophageal and/or tracheobronchial stenting is the most common treatment. Surgical reconstructive procedures are predominantly reserved for patients with a treatment refractory fistula or aseptic multiple organ failure. The prognosis is particularly influenced by the underlying disease.

Isolated Esophageal Crohn’s Disease with Diffuse Stricture

Background: Esophageal strictures are considered to be one of the most challenging matters for gastroenterologist, general and thoracic surgeons in diagnosis and management. They can be grouped into three general categories: intrinsic diseases, extrinsic diseases, and diseases that disrupt esophageal peristalsis and/or lower esophageal sphincter (LES) function. Crohn’s disease (CD) is a very rare cause of esophageal stricture. The prevalence of esophageal CD ranges from 1% to 2% in adults with CD. It is almost diagnosed lately when complications have occurred as Strictures, fissures, esophagobronchial fistulas, and mediastinal abscesses. Case Report: Thirty-nine years old Kurdish patient, referred to our department for evaluation. Although many consultations during the last two years, the Pt was still undiagnosed. She had progressive dysphagia, and weight loss of about 25 kg. She had no other digestive or extra digestive complaint, nor caustic ingestion history and nor drug history. Chest CT scan and UGI Contrast study revealed diffuse smooth and regular esophageal stenosis. Attempts to do upper endoscopy and biopsy failed due to severe stenosis. Prolonged medical history and radiologic signs exclude malignancy, so esophagectomy with stomach pull-through was done by the aid of VATS and laparoscopy with excellent results. Pathological finding of the resected esophagus suggested the diagnosis of Crohn’s disease CD. Conclusions: CD is a rare cause of esophageal stricture and still to be a challenging early diagnosis due to the low specificity of clinical manifestations (aphthous ulcers), histologic findings (absence of granulomas), and endoscopic findings. So many patients have been diagnosed with complications (esophageal strictures, fistulas) which needed surgical treatment, adding greater morbidity and mortality. MIS (thoracoscopy-laparoscopy) is valuable in decreasing the morbidity and mortality and improving the quality of life for those patients.

RARE GASTROBRONCHIAL FISTULA MISTAKEN FOR ASPIRATION PNEUMONIA IN A PATIENT WITH ESOPHAGEAL CANCER: A CASE REPORT

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aspiration pneumonia in the setting of known esophageal cancer typically raises suspicion for dysphagia as the primary cause. Here, however, we present a rare case caused by a gastrobronchial fistula (GBF). This study was written according to the CARE case report guidelines [1]. CASE PRESENTATION: A 64 year old Caucasian female with stage IV esophageal cancer presented with acute nausea, vomiting and dyspnea. She had completed radiation and chemotherapy and underwent esophagogastrectomy with gastric pull through eight months prior. She presented with pulmonary sepsis and was treated with antibiotics. She then became acutely hypoxic and hypercapnic and required emergent intubation. An ETT cuff leak persisted despite radiographic confirmation of placement and appropriate cuff inflation. An urgent bronchoscopy showed bilious, projectile material in the RLL. An upper GI series – challenging given the high volume of gastric reflux – opacified the right mainstem bronchus below the carina. Concurrent bronchoscopy/endoscopy visualized a 1 cm gastric fistula at the surgical anastomosis without evidence of ulceration, infection or recurrent neoplasm, communicating with the posterior bronchus intermedius. Successful fistula closure was achieved with endoscopic OverStitch (TM). DISCUSSION: GBFs are rare, and can occur in the setting of infection, neoplasm, trauma or ulcers [2]. One clue is a persistent ETT cuff leak and a high volume of gastric contents refluxing into the ventilatory circuit. The persistence of hypercapnia despite high minute ventilation (presumably from increased physiologic dead space) should also raise suspicion for GBF [2]. GBFs are rarer than esophagobronchial fistulas. In this case, the proximity of the bronchial tree to the thoracic gastric pull through likely contributed to the GBF. A novel feature of this case was the treatment, achieved via an endoscopic OverStitch. Whereas typical treatment might involve the placement of stents on both sides of an enteropulmonic fistula, the OverStitch technique is able to create a tighter, full thickness closure without the complications of in-dwelling stents [3]. CONCLUSIONS: In patients with refractory aspiration pneumonia and an esophagogastric surgical history, consider GBF as a possible cause. Initial testing is an upper GI series followed by dual bronchoscopy and endoscopy for diagnosis and fistulotomy. Reference #1: Riley DS, Barber MS, Kienle GS, AronsonJK, et al. CARE guidelines for case reports: explanation and elaboration document. JClinEpi 2017 Sep;89:218-235. doi: 10.1016/jclinepi.2017.04.026 Reference #2: Greenberg S, Kanth N, Kanth A. A woman with cough: gastrobronchial fistula as a delayed complication of bariatric surgery. Case report and literature review. Am J Emerg Med. 2015;33(4):597.e1-597.e5972. doi:10.1016/j.ajem.2013.11.022 Reference #3: Chon SH, Toex U, Plum PS, et al. Efficacy and feasibility of OverStitch suturing of leaks in the upper gastrointestinal tract [published online ahead of print, 2019 Oct 7]. Surg Endosc. 2019;10.1007/s00464-019-07152-8. doi:10.1007/s00464-019-07152-8 DISCLOSURES: No relevant relationships by Alan Gandler, source=Web Response No relevant relationships by Eric Gold, source=Web Response No relevant relationships by Prarthna Kulandaisamy, source=Web Response

Five Steps to Success - Advanced Interdisciplinary Endoscopic Therapy in a Case of an Intrathoracic Insufficiency of the Esophagogastrostomy and the Development of a Significant Esophagobronchial Fistula

Introduction: Endoscopic negative pressure therapy (ENPT) is an effective new method to treat patients with anastomotic insufficiencies of the upper gastrointestinal tract. Development of an esophagobronchial fistula in situation of postesophagectomy anastomotic insufficiency is a rare but challenging and potentially life-threatening complication. In cases of contact to the respiratory tract ENPT is non-operatively because of air leakage.

O148 SHORT-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIATION FOR CANCER

Abstract Aim The aim of this study was to clarify if prolonged time to surgery (TTS) improves postoperative outcomes in the curative intended treatment of an junctional cancer. Background & Methods sophagectomy is conventionally performed 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, studies have shown that prolonged TTS might be favourable. A randomized multicentre clinical trial was performed with allocation to 4-6 or 10-12 weeks between finished nCRT and surgery. All patients received nCRT according to CROSS. Primary outcome of thstudy was postoperative. Smortality, need for intensive care, and length of hospital stay. Results The study randomized 248 patients, 202have to date undergone esophagectomy 98 patients were allocated to prolonged TTS, and the groups were well matched concerning baseline characteristics. Postoperative complications were reported in 106 patients (52.5%).There was no difference in postoperative Clavien-Dindo score.In the standardgroup 17 (16.4%) patients had anastomotic leak compared to 19 (19.4%) in the prolongedgroup (P=0.572). Conduit necrosis was reported in 9 (4.5%) patients, esophago-bronchial fistula in 1 (0.5%) patient,chyle leak in 5 (2.5%) neumoni in 54 (26.7%) patients and respiratory insufficiency in 36 (17.8%) patients without significant difference . In the standard group 5 (4.8%) patients had postoperative mortality due to a complication, compared to 2 (2.0%) patients in the prolonged group (P=0.446). Median length of hospital stay was 14 days in the standard group and 17.5 days in the prolonged group (P=0.040). Conclusion In this we found no significant differences in postoperative mortality comparing standard to prolonged TTS after nCRT. Although, an observandum is that the median length of hospital stay was significantly longer in the prolonged group. We need to compare response and survival to properly evaluate prolonged TTS, but these results suggest that timing is not cardinal in short-term postoperative outcomes.

Esophagobronchial fistula after sleeve gastrectomy successfully treated by endoscopic submucosal dissection and over-the-scope clip

Esophagobronchial fistula after sleeve gastrectomy successfully treated by endoscopic submucosal dissection and over-the-scope clip

Surgical treatment of esophagotracheal and esophagobronchial fistulas

Esophagotracheal and esophagobronchial fistulas are pathological communications between the airway system and the digestive tract, which often lead to major pulmonary complications with a high mortality. Endoscopic treatment is the primary therapeutic approach; however, in cases of failure early surgical treatment is obligatory. This article describes the clinical course of patients with esophagotracheal and esophagobronchial fistulas treated in this hospital over aperiod of 10 years. Patients were retrospectively analyzed with respect to the etiology of fistulas, management, in particular to the operative procedures, complications and outcome. Between 2009 and 2019, atotal of 15patients with esophagotracheal and esophagobronchial fistula were treated in this hospital. Of these 12 underwent an endoscopic intervention, of which 5 were successful. In total, eight patients needed surgical intervention, six of the eight surgically treated patients recovered fully, one had arecurrent fistula, which was successfully treated by subsequent endoscopy after surgery and one patient died. Management of esophagotracheal and esophagobronchial fistulas is challenging. This retrospective analysis reflects the published data with asuccess rate of endoscopic treatment in approximately 50%. Surgical intervention should be carried out after unsuccessful endoscopic treatment or if endoscopic treatment is primarily not feasible. Direct closure with resorbable sutures or reconstruction with alloplastic or allogeneic material should be preferred. For larger defects or high proximal esophagotracheal fistulas local transposition of muscular flaps or free muscular flaps play amajor role. During operative closure of high intrathoracic or cervical fistulas, intraoperative neuromonitoring can be useful to prevent nerve damage.

DOZ047.74: Long-term outcome of preserving the native esophagus in long-gap esophageal atresia by thoracoscopic traction technique

Abstract Background Long-gap esophageal atresia (LGEA) is defined as atresia without distal tracheoesophageal fistula. Preserving the native esophagus is considered superior over intestinal interposition. Thoracoscopic traction technique facilitates lengthening of the esophageal ends, and allows anastomosis within the first weeks of life. The aim of this study was to evaluate the long-term outcome of LGEA patients treated by thoracoscopic traction technique. Methods From 2007 to 2018, 13 consecutive patients with LGEA were treated by thoracoscopic traction technique. During the first operation a bronchoscopy was performed to evaluate the presence of a proximal fistula. Then thoracoscopic traction sutures were placed at both esophageal ends. Initially a gastrostomy was performed. However, nowadays only a gastropexy is performed to prevent the stomach from migrating into the thorax. Approximation of the esophageal ends was evaluated by postoperative X-rays. Thoracoscopic adhesiolysis was performed when necessary. Both ends were anastomosed during the final surgical procedure, usually within a week. Results In 11 patients the anastomosis could be completed by thoracoscopic traction technique. In two patients the elongation procedure failed. In the first patient the sutures tore out. The second patient had an accidental perforation of the proximal pouch by the Replogle tube. Median time on ventilation until after the final anastomosis was 14 days (range 4–34 days). Five patients required chest tube drainage for anastomotic leakage. The median hospitalization time during the first admission was 47 days (range 31–170 days). All patients needed a median of 4 (range 1–16) dilatations for anastomotic stenosis. Ten patients needed a fundoplication within a median time of 8 weeks (range 2–16 weeks) after the esophageal anastomosis. One patient developed an esophago-bronchial fistula. Median weight at age of 2 years was −1.88 SD (range −3.54 – −0.16) and at age of 4 years −1.53 SD (range −2.94–0.66). All patients tolerated full oral feeding. Conclusion LGEA can be treated successfully after elongation by thoracoscopic traction technique. The procedure leads to an earlier anastomosis and shorter initial hospital stay as compared to delayed primary anastomosis. Full oral feeding is possible in all patients. Dilatation for anastomotic strictures and antireflux surgery is necessary in (almost) all patients.

Outcome after accidental food bolus-induced esophageal perforation

Objectives: Food bolus-induced esophageal perforation is much more seldom than iatrogenic and emetic esophageal rupture. We present results from a non-operative treatment approach as well as long-term functional outcome.Materials and methods: Medical records of 10 consecutive patients with food bolus-induced esophageal perforation from October 2007 to May 2015 were retrospectively registered in a database. Six patients developed perforation related to endoscopic removal of impacted food, and four during esophageal passage of bone, meat or bread. Treatment was sealing the perforation by stenting (n = 7) with (n = 4) or without (n = 3) chest tube drainage, chest tube drainage (n = 1), observation (n = 1) and gastroesophageal resection (n = 1) because of concomitant emesis of gastric effluent. After median 51 months nine patients reported about dysphagia, fatigue and health-related quality of life.Results: Ten patients aged median 62.5 years (range 30–85) stayed in our hospital for 12 days (5–68 days). There was no treatment-related mortality. Nine patients were alive 63 months (18–126) after perforation. Five needed restenting (leakage, migration, impacted stent), two had drainage of a mediastinal abscess, one patient developed a transient esophagobronchial fistula. Dysphagia score was 0 (0–1). One patient developed dysphagia for some solid food. Scores for fatigue and HRQoL was similar to a Norwegian reference population.Conclusion: Treatment mainly with a non-operative approach occurred without mortality. Complications were handled by restenting and abscess drainage. Functional result for dysphagia was excellent. Interesting results on fatigue and HRQoL must be interpreted with caution because of a limited patient material.