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Minakari M, Sedaghat N. Endoscopic clipping of a complicated esophageal perforation following pneumatic dilation for achalasia: A case study and literature review. Clin Case Rep 2022; 10:e6620. [PMCID: PMC9701890 DOI: 10.1002/ccr3.6620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mohammad Minakari
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Nahad Sedaghat
- School of Medicine Isfahan University of Medical Sciences Isfahan Iran
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2
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Abstract
The development of new endoscopic techniques, such as gastrointestinal (GI) stenting, full-thickness suturing, clip application, and use of tissue adhesives, has had a significant impact on management of GI fistulae. These techniques have shown promising results, but further study is needed to optimize the efficacy of long-term closure. The advancement of endoscopic techniques, including the use of the lumen apposing metal stent (LAMS), has allowed for the deliberate creation of fistula tracts to apply endoscopic therapy that previously could not be achieved. This article examines the rapidly evolving area of endoscopic fistula closure and its relationship to LAMS.
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Affiliation(s)
- Jaehoon Cho
- Department of Internal Medicine, Los Angeles County and University of Southern California Medical Center, 2020 Zonal Avenue, IRD 620, Los Angeles, CA 90033, USA
| | - Ara B Sahakian
- Division of Gastrointestinal and Liver Diseases, University of Southern California Keck School of Medicine, 1510 San Pablo Street, Los Angeles, CA 90033, USA.
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3
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Abstract
OPINION STATEMENT Esophageal leaks (EL) and ruptures (ER) are rare conditions associated with a high risk of mortality and morbidity. Historically, EL and ER have been surgically treated, but current treatment options also include conservative management and endoscopy. Over the last decades, interventional endoscopy has evolved as an effective and less invasive alternative to primary surgery in these cases. A variety of techniques are currently available to re-establish the continuity of the digestive tract, prevent or treat infection related to the leak/rupture, prevent further contamination, drain potential collections, and provide nutritional support. Endoscopic options include clips, both through the scope (TTS) and over the scope (OTS), stent placement, vacuum therapy, tissue adhesive, and endoscopic suturing techniques. Theoretically, all of these can be used alone or with a multimodality approach. Endoscopic therapy should be combined with medical therapy but also with percutaneous drainage of collections, where present. There is robust evidence suggesting that this change of therapeutic paradigm in the form of endoscopic therapy is associated with improved outcome, better quality of life, and shortened length of hospital stay. Moreover, recent European guidelines on endoscopic management of iatrogenic perforation have strengthened and to some degree regulated and redefined the role of endoscopy in the management of conditions where there is a breach in the continuity of the GI wall. Certainly, due to the complexity of these conditions and the variety of available treatment options, a multidisciplinary approach is strongly recommended, with close clinical monitoring (by endoscopists, surgeons, and intensive care physicians) and special attention to signs of sepsis, which can lead to the need for urgent surgical management. This review article will critically discuss the literature regarding endoscopic modalities for esophageal leak and perforation management and attempt to place them in perspective for the physician.
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Saxena P, Khashab MA. Endoscopic Management of Esophageal Perforations: Who, When, and How? ACTA ACUST UNITED AC 2017; 15:35-45. [PMID: 28116696 DOI: 10.1007/s11938-017-0117-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Esophageal perforations can be spontaneous or iatrogenic. Although they are a rare occurrence, they are associated with a significant morbidity and mortality. Traditionally, management of esophageal perforation consisted of surgery. However, endoscopic management is now emerging as the primary treatment modality and is less invasive and morbid than surgery. Endoscopic modalities include through-the-scope clips (TTS), over-the-scope clips (OTSC), placement of covered stents, and suturing. Suturing can be used for primary closure of the perforation as well as anchoring of stents to prevent migration. Smaller defects (<2 cm) can be closed with clips (TTS or OTSC), whereas larger defects require a stent placement or suturing to achieve closure. If the perforation is associated with a mediastinal collection, drainage is mandatory and can be done via CT-guided percutaneous drainage, surgery, or endoscopic vacuum therapy.
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Affiliation(s)
- Payal Saxena
- Department of Medicine and Division of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1800 Orleans St, Suite 7125B, Baltimore, MD, 21205, USA
| | - Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, 1800 Orleans St, Suite 7125B, Baltimore, MD, 21205, USA.
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5
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Kim H. Over-the-Scope Clip in the Management of Gastrointestinal Defect and Intractable Non-Variceal Bleeding. Clin Endosc 2017; 50:3-5. [PMID: 28147475 PMCID: PMC5299984 DOI: 10.5946/ce.2017.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hyungkil Kim
- Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Angsuwatcharakon P, Rerknimitr R. Endoscopic closure of iatrogenic perforation. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii150009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Phonthep Angsuwatcharakon
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Lázár G, Paszt A, Mán E. Role of endoscopic clipping in the treatment of oesophageal perforations. World J Gastrointest Endosc 2016; 8:13-22. [PMID: 26788259 PMCID: PMC4707319 DOI: 10.4253/wjge.v8.i1.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/25/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
With advances in endoscopic technologies, endoscopic clips have been used widely and successfully in the treatment of various types of oesophageal perforations, anastomosis leakages and fistulas. Our aim was to summarize the experience with two types of clips: The through-the-scope (TTS) clip and the over-the-scope clip (OTSC). We summarized the results of oesophageal perforation closure with endoscopic clips. We processed the data from 38 articles and 127 patients using PubMed search. Based on evidence thus far, it can be stated that both clips can be used in the treatment of early (< 24 h), iatrogenic, spontaneous oesophageal perforations in the case of limited injury or contamination. TTS clips are efficacious in the treatment of 10 mm lesions, while bigger (< 20 mm) lesions can be treated successfully with OTSC clips, whose effectiveness is similar to that of surgical treatment. However, the clinical success rate is significantly lower in the case of fistulas and in the treatment of anastomosis insufficiency. Tough prospective randomized multicentre trials, which produce the largest amount of evidence, are still missing. Based on experience so far, endoscopic clips represent a possible therapeutic alternative to surgery in the treatment of oesophageal perforations under well-defined conditions.
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Baruah A, Kee Song LMW, Buttar NS. Endoscopic management of fistulas, perforations, and leaks. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015. [DOI: 10.1016/j.tgie.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Predictors of Successful Endoscopic Closure of Gastrointestinal Defects: Experience from a Single Tertiary Care Center. J Gastrointest Surg 2015; 19:1691-8. [PMID: 26070889 DOI: 10.1007/s11605-015-2868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/28/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS Endoscopic closure is technically feasible in the majority of gastrointestinal defects. The aim of this study is to evaluate the technical and clinical outcomes, and identify variables predicting successful outcomes in patients with attempted closure. METHODS This is a retrospective study of patients undergoing endoscopic closure of gastrointestinal defects between December 2007 and May 2013 at a single tertiary care center. Technical success (TS) was defined as successful closure of the defect at the time of endoscopy. Clinical improvement (CI) was defined as improvement in symptoms. Clinical resolution (CR) was defined as documented radiographic closure of defect or clinical resolution of symptoms. Acute defects were diagnosed within 6 weeks, while chronic defects were those that persisted for >6 weeks, prior to index therapeutic endoscopy. RESULTS Fifty patients underwent 77 endoscopies for leaks (n = 23), fistulas (n = 22), and perforations (n = 5). TS occurred in 46/50 (92%). Overall, 34/50 (68%) patients had CR. CR was significantly higher for acute defects as compared to chronic defects (89.7 vs. 38.1%, OR 14.1, CI 3.19-62.1, p < 0.001). Of 24 patients who required repeat attempts at endoscopic closure, 14 (58%) achieved CR. Acute defects (p = 0.04) and those with initial CI (p = 0.001) were statistically more likely to achieve CR after a repeat attempt. CONCLUSION TS and CR are achieved in majority of patients. Acute defects are more likely to achieve CR. In cases where a defect persists, a repeat attempt at endoscopic closure should be attempted.
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Sarıkaş NG, Korkmaz T, Kahramansoy N, Kılıçgün A, Boran Ç, Boztaş G. The effects of ankaferd blood stopper on the recovery process in an experimental oesophageal perforation model. Balkan Med J 2015; 32:96-100. [PMID: 25759779 DOI: 10.5152/balkanmedj.2015.15459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/28/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Oesophageal perforation is a life-threatening pathology that is generally treated conservatively; however, surgical procedures are frequently performed. A topical haemostatic agent, Ankaferd Blood Stopper (ABS), also has beneficial wound-healing effects. AIMS This study aimed to determine the effects of ABS following experimental oesophageal perforations. STUDY DESIGN Animal experiment. METHODS The experimental rats were classified into 6 groups (with 7 rats in each group). Pairs of groups (primary repair alone and primary repair + ABS) were terminated in the 1(st), 2(nd), and 3(rd) weeks following injury. The oesophageal perforations, which were 8-10 mm in length, were created using a nasogastric tube. The perforation sites were repaired with a 6-0 polyglactine thread in the primary repair groups. Additionally, ABS was sprayed over the perforation site in the treatment groups. Each oesophagus was evaluated histopathologically. RESULTS There were fewer microabscesses and areas of necrosis in the ABS groups compared with the primary repair groups. The histopathological evaluation revealed that the ABS groups had less inflammation and more re-epithelisation compared to the primary repair groups (p=0.002 and p=0.003, respectively). Fibrosis in the ABS groups was moderate in the 2(nd) week and mild in the 3(rd) week. Comparing the groups with respect to the time intervals, only the 1(st) week groups showed a significant difference in terms of re-epithelialisation (p=0.044). CONCLUSION Topical ABS application on the repaired experimental oesophageal perforation regions led to positive wound-healing effects compared with the rats that were administered the primary repair alone.
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Affiliation(s)
- Necla Gürbüz Sarıkaş
- Department of Pediatric Surgery, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tanzer Korkmaz
- Department of Emergency Medicine, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Nurettin Kahramansoy
- Department of General Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ali Kılıçgün
- Department of Thoracic Surgery, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Çetin Boran
- Department of Pathology, Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
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11
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Cap-assisted clip closure of large esophageal perforations caused by a duodenoscope during endoscopic retrograde cholangiopancreatography (with video). Surg Laparosc Endosc Percutan Tech 2015; 24:e101-5. [PMID: 24710255 DOI: 10.1097/sle.0b013e318293c4b6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS Esophageal perforation is a rare complication of endoscopic retrograde cholangiopancreatography and the perforation is usually too large to close with endoclips. We developed an endoscopic procedure for the perforations. METHODS A gastroscope fitted with a cap was inserted into the esophagus to perform the clip closure. The closure procedure was divided in 3 steps: step 1 is large clip closure; step 2 is small clip closure; and step 3 is the nasogastric tube placement for drainage. RESULTS A total of 4 patients underwent a cap-assisted clip closure and the procedures were completed successfully within 30 minutes. The cure was achieved in all the 4 patients after a relatively short period of hospital stay and no patient complained of closure-related complication. CONCLUSIONS The cap-assisted clip closure procedure is effective, safe, and easy to carry out for the closure of large esophageal perforations. It may also be applied to perform the closure of large perforations at other sites of the digestive tract.
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12
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Stavropoulos SN, Modayil R, Friedel D. Closing perforations and postperforation management in endoscopy: esophagus and stomach. Gastrointest Endosc Clin N Am 2015; 25:29-45. [PMID: 25442956 DOI: 10.1016/j.giec.2014.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Luminal perforation after endoscopy is a dreaded complication that is associated with significant morbidity and mortality, longer and more costly hospitalization, and the specter of potential future litigation. The management of such perforations requires a multidisciplinary approach. Until recently, surgery was required. However, nowadays the endoscopist has a burgeoning armamentarium of devices and techniques that may obviate surgery. This article discusses the approach to endoscopic perforations in the esophagus and stomach.
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Affiliation(s)
- Stavros N Stavropoulos
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA.
| | - Rani Modayil
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA
| | - David Friedel
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA
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13
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Over-the-scope clip in the management of GI defects. Gastrointest Endosc 2014; 80:623-625. [PMID: 25220510 DOI: 10.1016/j.gie.2014.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/04/2014] [Indexed: 02/06/2023]
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Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg 2014; 97:1029-35. [PMID: 24444874 DOI: 10.1016/j.athoracsur.2013.11.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Esophageal perforation is a serious disease with a high morbidity and mortality rate. Endoscopic vacuum therapy (EVT) is a new endoscopic treatment option, which is used to treat anastomotic leakages after rectal and esophageal resections. We report on 10 patients treated with EVT for esophageal perforation. METHODS Clinical and therapy-related data such as age, sex, duration of intensive care stay, length of hospital stay, reasons for perforation, EVT-associated complications, mortality, need for alternative treatment options, and course of infectious variables were analyzed. RESULTS Ten patients were treated with 54 vacuum sponges that were placed in upper gastrointestinal defects. Causes for perforation were iatrogenic, spontaneous, or foreign body-associated. Mean number of sponge insertions was 5.4 (range, 2 to 12) with a mean period of 19 ± 14.26 days. Successful therapy was achieved in 9 of 10 patients. After successful primary treatment, 1 patient died during therapy as a result of general failure of the cardiovascular system. In 1 patient, surgical resection was necessary after repeated Mallory-Weiss lesions and minor perforations during the course of immunosuppressive therapy. In a third patient an endoscopic stent was inserted in the clean wound cavity after primary EVT. CONCLUSIONS In this small trial EVT has been shown to be a safe and feasible therapy option for perforations of the upper gastrointestinal tract. If necessary, EVT can be combined with operative revision for better control of the local septic focus or used as a bridging procedure for wound conditioning before aggressive surgical treatment.
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Raju GS. Endoscopic clip closure of gastrointestinal perforations, fistulae, and leaks. Dig Endosc 2014; 26 Suppl 1:95-104. [PMID: 24373001 DOI: 10.1111/den.12191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023]
Abstract
Development of endoscopic devices to close perforations has certainly revolutionized endoscopy. Immediate closure of perforations eliminates the need for surgery, which allows us to push the limits of endoscopic surgery from the mucosal plane to deep submucosal layers and eventually transmurally. The present article focuses on endoscopic closure devices, closure techniques, followed by a review of animal and clinical studies on endoscopic closure of perforations.
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Affiliation(s)
- Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, USA
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Hourneaux de Moura EG, Toma K, Goh KL, Romero R, Dua KS, Felix VN, Levine MS, Kochhar R, Appasani S, Gusmon CC. Stents for benign and malignant esophageal strictures. Ann N Y Acad Sci 2013; 1300:119-143. [PMID: 24117639 DOI: 10.1111/nyas.12242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This paper presents commentaries on endotherapy for esophageal perforation/leaks; treatment of esophageal perforation; whether esophageal stents should be used for treating benign esophageal strictures; what determines the optimal stenting period in benign esophageal strictures/leaks; how to choose an esophageal stent; how a new fistula secondary to an esophageal stent should be treated; which strategy should be adopted when a fistula of a cervical anastomosis occurs; intralesional steroids for refractory esophageal strictures; balloon and bougie dilators for esophageal strictures and predictors of response to dilation; whether refractory strictures from different etiologies respond differently to endotherapy; surgical therapy of benign esophageal strictures; and whether stenoses following severe esophageal burns should be treated by esophageal resection or esophageal bypass.
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Affiliation(s)
| | - Kengo Toma
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Khean-Lee Goh
- Division of Gastroenterology and GI Endoscopy, University of Malaya, Kuala Lumpur, Malaysia
| | - Ronald Romero
- Division of Gastroenterology and GI Endoscopy, University of Malaya, Kuala Lumpur, Malaysia
| | - Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Marc S Levine
- Department of Gastrointestinal Radiation, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreekanth Appasani
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Carla Cristina Gusmon
- Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universdade de São Paulo, São Paulo, Brazil
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Abstract
Endoscopy has an ever-increasing role in the treatment of complications in digestive surgery. Endoscopic treatment is essentially used for (i) fistula or intra-abdominal collection secondary to anastomotic dehiscence and (ii) anastomotic stricture, especially esophagogastric, but also sometimes after colorectal surgery. First intention treatment of fistula following esophagogastric surgery is the insertion of an extractable self-expandable metallic stent (partially or entirely covered); this is supported by a low level of scientific evidence, but clinical experience has been satisfactory. Other techniques for treatment of anastomotic leak have also been reported anecdotally (clip placement, sealing with glue). There are few data available in the literature on endoscopic management (stents essentially) of postoperative colonic fistula. Whatever the approach chosen to treat a postoperative digestive tract fistula, management is medico-surgical and cannot be limited to simple closure of the digestive tube wall defect. Drainage of any collections by endoscopic, radiologic or surgical approach, systemic treatment of infection and nutritional support are essential adjuvant treatment modalities. Treatment of postoperative esophageal or colonic strictures is essentially endoscopic and is based on initial dilatation (endoscopic with hydrostatic balloon or bougie), and placement of extractable metallic stents (partially or entirely covered) in case of refractory outcome.
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Affiliation(s)
- X Dray
- Université Paris Diderot, Paris 7, AP-HP, Service d'Hépatogastroentérologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Chirica M, Champault A, Dray X, Sulpice L, Munoz-Bongrand N, Sarfati E, Cattan P. Esophageal perforations. J Visc Surg 2010; 147:e117-28. [PMID: 20833121 DOI: 10.1016/j.jviscsurg.2010.08.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy.
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Affiliation(s)
- M Chirica
- Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
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Bleier BS, Gratton MA, Leibowitz JM, Palmer JN, Newman JG, Cohen NA. Laser-welded endoscopic endoluminal repair of iatrogenic esophageal perforation: an animal model. Otolaryngol Head Neck Surg 2009; 139:713-7. [PMID: 18984269 DOI: 10.1016/j.otohns.2008.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/21/2008] [Accepted: 08/05/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test the feasibility of laser tissue welding (LTW) in creating an endoscopic transluminal repair of esophageal perforation. STUDY DESIGN Animal model. SUBJECTS AND METHODS A diode laser was used to create an endoluminal rabbit esophageal perforation repair. Burst pressures were compared with open incision, external suture, and external laser-augmented suture closure. Comparisons were performed five times and analyzed with Kruskal-Wallis analysis of variance and a post hoc Dunn method. RESULTS The burst threshold of the endoluminal weld (54.78 +/- 5.84 mm Hg) was significantly higher than that of the open incision (6.5 +/- 1.94 mm Hg) and not significantly different than that of the external suture (37.18 +/- 1.97 mm Hg) or the laser-augmented suture group (71.60 +/- 7.58 mm Hg). CONCLUSION Laser welding is a feasible method of creating endoluminal repairs with burst strengths comparable with external suture repair, which may allow a subset of patients to avoid traditional open approaches. This is the first reported animal model of LTW for endoscopic closure of iatrogenic esophageal perforation.
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Affiliation(s)
- Benjamin S Bleier
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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20
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Oláh T. [Surgery of oesophagus]. Magy Seb 2008; 61:312-319. [PMID: 19073486 DOI: 10.1556/maseb.61.2008.6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Tibor Oláh
- Siófok Városi Kórház Altalános Sebészeti Osztály Siófok
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21
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Treatment of anastomotic leaks after esophagectomy with endoscopic hemoclips. J Thorac Cardiovasc Surg 2008; 137:766-7. [PMID: 19258111 DOI: 10.1016/j.jtcvs.2008.01.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Accepted: 01/20/2008] [Indexed: 11/20/2022]
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