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Xu W, Jiang H, Liu Y, Liu X, Jiang Y. Retrospective cohort study on treatment modalities and survival time after oesophageal fistula in patients with oesophageal cancer in a regional cancer care centre in China. BMJ Open 2023; 13:e069703. [PMID: 37045573 PMCID: PMC10106048 DOI: 10.1136/bmjopen-2022-069703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Oesophageal fistula (perforation) is a devastating complication in patients with oesophageal cancer . The optimal treatment remains uncertain. OBJECTIVE We sought to present real-world evidence on treatment modalities and survival postfistula in patients with oesophageal cancer. DESIGN, SETTINGS AND MAIN OUTCOMES This was a retrospective cohort study of patients with oesophageal cancer with oesophageal fistulae diagnosed between June 2010 and June 2020 in a regional cancer care centre in Zhengzhou, China (n=352). The treatment options included surgical resection, oesophageal stent grafting, gastrostomy, nasogastric tube and conservative care. The primary outcome was survival time (months) postfistula. Inverse probability of treatment weighting (IPTW) life regression was used to estimate the differences in survival time accounting for potential confounders. RESULTS The median survival time was 2.3 months (IQR: 0.7-6.0 months). Survival times were shorter in patients of male sex, T4 stage and oesophagotracheal versus oesophageal-mediastinal fistulae, and longer for any treatment option versus conservative care. The IPTW life regression analyses showed that in patients with oesophagotracheal fistulae, survival times were longer for stent grafting (+0.90 (95% CI 0.60 to 1.19) months) or gastrostomy (+0.81 (95% CI 0.47 to 1.13) months) versus nasogastric tube. In patients with oesophageal-mediastinal fistulae, survival times were shorter for stent grafting versus nasogastric tube (-0.36 (95% CI -0.63 to -0.09) months) and gastric tube (-0.29 (95% CI -0.50 to -0.08) months). Surgical resection was recorded in nine patients with oesophageal-mediastinal fistulae, and it was associated with the longest survival time in these patients. CONCLUSIONS Stent grafting or gastrostomy may be preferable to nasogastric tube in survival prognosis for patients with oesophageal cancer with oesophagotracheal fistulae. In contrast, stent grafting may be not preferable to nasogastric tube or gastrostomy in survival prognosis for patients with oesophageal-mediastinal fistulae.
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Affiliation(s)
- Wencai Xu
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Hui Jiang
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Yang Liu
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Xiao Liu
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Yue Jiang
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
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Dudzic W, Płatkowski C, Folwarski M, Meyer-Szary J, Kaźmierczak-Siedlecka K, Ekman M, Wojciechowicz T, Dobosz M. Nutritional Status and the Outcomes of Endoscopic Stenting in Benign and Malignant Diseases of Esophagus. Nutrients 2023; 15:nu15061524. [PMID: 36986253 PMCID: PMC10053737 DOI: 10.3390/nu15061524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Endoscopic stenting (ES) is a widely known method for palliative dysphagia treatment in esophageal strictures. Esophageal cancer is often associated with advanced malnutrition, which may increase the risk of complications of the procedure. The aim of this study was to evaluate complication rates and the impact of nutritional status on the outcomes of ES. PATIENTS AND METHODS A single-center retrospective study was conducted at Copernicus Hospital in Gdańsk, Poland. Adult patients who underwent endoscopic stenting between February 2014 and December 2018 were included. The influence of patient characteristics (age, sex, indications for esophageal stenting, and location of stenosis) and nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) on complication rates and survival were analyzed. RESULTS Eighty-one patients (69% men) were enrolled in the study. In 69%, the indication for ES was malignancy (mainly esophageal cancer). The median dysphagia score significantly decreased from 2.8 to 0.6 after the procedure (p < 0.001). Complications were observed in 27% (n = 22) of the patients. Early complications were bleeding (2.5%), stent unexpansion (2.5%), and stent migration during the procedure (3.7%). There were no early fatal complications of the procedure. Late complications included: stent migration (6.2%), tissue overgrowth (6.2%), food impaction (2.2%), fistula formation (3.7%), bleeding (3.7%), and stent malposition (1.2%). A total of 76% of the participants scored ≥ 3 points in nutritional screening (NRS2002) and 70% were diagnosed with severe malnutrition (GLIM -stage 2). A stent diameter of < 2.2 cm compared with ≥ 2.2 was associated with a higher rate of migrations (15.5% vs. 2.5%). The median survival time in the malignant group was 90 days. Histopathological diagnosis and patients' nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) had no significant effect on complication rates and survival after esophageal stent insertion. CONCLUSIONS Endoscopic stenting is a relatively safe procedure for the palliative treatment of esophageal strictures. Severe malnutrition, although common, does not affect the outcomes of the procedure.
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Affiliation(s)
- Wojciech Dudzic
- Department of General and Gastrointestinal Surgery and Nutrition, Copernicus Hospital Gdansk, 80-336 Gdansk, Poland
| | - Cezary Płatkowski
- Department of General and Gastrointestinal Surgery and Nutrition, Copernicus Hospital Gdansk, 80-336 Gdansk, Poland
| | - Marcin Folwarski
- Department of Clinical Nutrition, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jarosław Meyer-Szary
- Department of Paediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Karolina Kaźmierczak-Siedlecka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marcin Ekman
- Department of Surgical Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Tomasz Wojciechowicz
- Department of General and Gastrointestinal Surgery and Nutrition, Copernicus Hospital Gdansk, 80-336 Gdansk, Poland
| | - Marek Dobosz
- Department of General and Gastrointestinal Surgery and Nutrition, Copernicus Hospital Gdansk, 80-336 Gdansk, Poland
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Willems S, Daemen JHT, Hulsewé KWE, Belgers EHJ, Sosef MN, Soufidi K, Vissers YLJ, de Loos ER. Outcomes after hybrid minimally invasive treatment of Boerhaave syndrome: a single-institution experience. Acta Chir Belg 2022:1-6. [PMID: 35020548 DOI: 10.1080/00015458.2022.2029035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Spontaneous esophageal perforation or Boerhaave syndrome is a life-threatening emergency, associated with significant morbidity and mortality. In this retrospective series we describe our single-center experience with a hybrid minimally invasive treatment approach for the treatment of Boerhaave syndrome. METHODS Clinical data of all patients who presented with spontaneous esophageal rupture between January 2009 and December 2019 were analyzed. All patients underwent esophageal endoscopic stenting to seal the perforation and debridement of the contaminated mediastinal and pleural cavity through video-assisted thoracoscopic surgery (VATS). Primary outcome measure was defined as in-hospital death and 30-day mortality. RESULTS Twelve patients were included with a median age of 63 years (interquartile range [IQR] 51-74 years) of whom 58% (n = 7) were male. The median Pittsburg perforation severity score was 6.5 (IQR 6-9). Endoscopic reintervention was required in 8 patients (67%), primarily due to stent dislocation. In addition, 5 patients (42%) required re-VATS due to empyema formation. Thirty-day mortality and in-hospital mortality were respectively 17% (n = 2) and 25% (n = 3). CONCLUSION Endoscopic stenting in combination with thoracoscopic debridement is an effective and safe minimally invasive hybrid approach for the treatment of Boerhaave syndrome. This is depicted by the relatively low mortality rates, even among patients with high perforation severity scores. The relatively low mortality rates may be attributed to the combined approach of rapidly sealing the defect and decontamination of the thorax. Future studies should aim to corroborate this evidence which is limited by its sample size and retrospective nature.
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Affiliation(s)
- Stefanie Willems
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Jean H. T. Daemen
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Karel W. E. Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Eric H. J. Belgers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Khalida Soufidi
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Yvonne L. J. Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Erik R. de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
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Śnieżyński J, Wilczyński B, Skoczylas T, Wallner GT. Successful Late Endoscopic Stent-Grafting in a Patient with Boerhaave Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931629. [PMID: 34385411 PMCID: PMC8370138 DOI: 10.12659/ajcr.931629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 53-year-old
Final Diagnosis: Spontaneous esophageal rupture
Symptoms: Chest pain • dyspena • hydropneumothorax • purulent discharge from the umbilicus • vomiting
Medication: —
Clinical Procedure: Endoscopic stent-grafting • enteral feeding • pleural drainage
Specialty: Gastroenterology and Hepatology • Surgery
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Affiliation(s)
- Jan Śnieżyński
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Bartosz Wilczyński
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Tomasz Skoczylas
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
| | - Grzegorz T Wallner
- Second Department of General & Gastrointestinal Surgery & Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Lublin, Poland
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Deng Y, Hou L, Qin D, Huang T, Yuan T. Current treatment and outcome of esophageal perforation: A single-center experience and a pooled analysis. Medicine (Baltimore) 2021; 100:e25600. [PMID: 33879724 PMCID: PMC8078246 DOI: 10.1097/md.0000000000025600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Esophageal perforation has been one of the serious clinical emergencies, because of the high mortality and complication rates. However, the current prognosis of esophageal perforation and the outcomes of available treatment methods are not well defined. This study attempted to pool the immediate outcomes of esophageal perforation in the past 2 decades. METHODS The clinical data of 22 consecutive adult patients with esophageal perforation in our center were analyzed. A pooled analysis was also conducted to summarize results from the literatures published between 1999 and 2020. Studies that met the inclusion criteria were assessed, and their methodological quality was examined. RESULTS The mortality and complication rates in our center were 4.55% and 31.82%, separately. The pooled analysis included 45 studies published between 1999 and 2019, which highlighted an overall immediate mortality rate of 9.86%. Surgical treatments were associated with a pooled immediate mortality of 10.01%, and for conservative treatments of 6.49%. Besides, in the past decade, the mortality and complication rates decreased by 27.12% and 46.75%, respectively. CONCLUSIONS In the past 2 decades, the overall immediate mortality rate of esophageal perforation was about 10% in the worldwide, and the outcomes of esophageal perforation treatment are getting better in the last 10 years. ETHICS REGISTRATION INFORMATION LW2020011.
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Affiliation(s)
| | - Luqi Hou
- Department of Research and Education, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545001, China
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Endoscopic Diagnosis and Management of Gastrointestinal Trauma. Clin Gastroenterol Hepatol 2021; 19:14-23. [PMID: 31605872 DOI: 10.1016/j.cgh.2019.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/28/2019] [Indexed: 02/07/2023]
Abstract
Trauma affects all sociodemographic profiles and is a major cause of morbidity and mortality particularly in patients less than forty years of age. A variety of endoscopic tools and techniques initially used for iatrogenic etiologies (post-operative bile or pancreatic duct leaks, intra-procedural perforation) have been adopted for use in the gastrointestinal trauma victim. The purpose of this review is to highlight a variety of gastrointestinal traumatic complications where endoscopy can serve a complement and/or definitive management strategy.
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Yan XL, Jing L, Guo LJ, Huo YK, Zhang YC, Yan XW, Deng YZ. Surgical management of Boerhaave's syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:669-674. [PMID: 32496118 DOI: 10.17235/reed.2020.6746/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND spontaneous esophageal rupture (Boerhaave's syndrome) is a rare and challenging clinical condition. OBJECTIVE to evaluate the outcome of different surgical treatments for patients with Boerhaave's syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. PATIENTS AND METHODS eighty-eight patients with Boerhaave's syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). RESULTS the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). CONCLUSIONS it is very important to establish an early diagnosis for patients with Boerhaave's syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.
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Affiliation(s)
- Xiao-Liang Yan
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University, china
| | - Li Jing
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Lin-Jing Guo
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Yun-Kui Huo
- Cardiovascular Surgery, The First Hospital of Shanxi Medical University,
| | - Yong-Cai Zhang
- Cardiovascular Surgery, The First Hospital of Shanxi Medical University,
| | - Xiu-Wen Yan
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Yong-Zhi Deng
- Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University,
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Conservative management of esophageal perforation caused by misplacement of endotracheal tube. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:100-102. [PMID: 31410099 PMCID: PMC6690153 DOI: 10.5114/kitp.2019.86364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/28/2019] [Indexed: 11/17/2022]
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Otsuka K, Murakami M, Ariyoshi T, Yamashita T, Goto S, Watanabe M, Aoki T. Endoscopic clipping of spontaneous esophageal rupture: Case reports of three patients. Int J Surg Case Rep 2017; 38:18-22. [PMID: 28750314 PMCID: PMC5526513 DOI: 10.1016/j.ijscr.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/27/2017] [Accepted: 07/03/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Spontaneous esophageal rupture is a life-threatening condition which is difficult to diagnose early, and is usually treated surgically. Prolonged hospitalization is common. Non-operative treatment of esophageal rupture localized to the mediastinum has been reported. We report three patients with spontaneous esophageal rupture successfully managed with endoscopic clipping. CASE PRESENTATIONS Two patients had ruptures localized to the mediastinum, and were discharged within one week of undergoing closure. The third patient presented with Boerhaave's syndrome with a leak into the pleural space and needed prolonged hospitalization (34days), but she did not need surgery and began oral intake two days after endoscopic clipping. The patient had an uneventful recovery.
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Affiliation(s)
- Koji Otsuka
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Masahiko Murakami
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Tomotake Ariyoshi
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Takeshi Yamashita
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Satoru Goto
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Makoto Watanabe
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Takeshi Aoki
- Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 142-8666 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
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