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Estorninho J, Pimentel R, Gravito-Soares M, Gravito-Soares E, Amaro P, Figueiredo P. Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:444-450. [PMID: 38476151 PMCID: PMC10928871 DOI: 10.1159/000527317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/30/2022] [Indexed: 03/14/2024]
Abstract
Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.
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Affiliation(s)
- João Estorninho
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Pimentel
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Adequate Management of Postoperative Complications after Esophagectomy: A Cornerstone for a Positive Outcome. Cancers (Basel) 2022; 14:cancers14225556. [PMID: 36428649 PMCID: PMC9688292 DOI: 10.3390/cancers14225556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Esophagectomy for cancer is one of the most complex procedures in visceral surgery. Postoperative complications negatively affect the patient's overall survival. They are not influenced by the histology type (adenocarcinoma (AC)/squamous cell carcinoma (SCC)), or the surgical approach (open, laparoscopic, or robotic-assisted). Among those dreadful complications are anastomotic leak (AL), esophago-respiratory fistula (ERF), and chylothorax (CT). METHODS In this review, we summarize the methods to avoid these complications, the diagnostic approach, and new therapeutic strategies. RESULTS In the last 20 years, both centralization of the medical care, and the development of endoscopy and radiology have positively influenced the management of postoperative complications. For the purpose of their prevention, perioperative measures have been applied. The treatment includes conservative, endoscopic, and surgical approaches. CONCLUSIONS Post-esophagectomy complications are common. Prevention measures should be known. Early recognition and adequate treatment of these complications save lives and lead to better outcomes.
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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. [PMID: 36447673 PMCID: PMC9701890 DOI: 10.1002/ccr3.6620] [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: 04/22/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
A transmural esophageal tear complicated by large size and unusual location was diagnosed in a 59-year-old man after undergoing pneumatic balloon dilation for achalasia. It was closed with six endo-clips. The patient recovered and was discharged with ordinary diet 8 days later, after receiving supportive care for a week.
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Affiliation(s)
- Mohammad Minakari
- Division of Gastroenterology, Department of Internal Medicine, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Nahad Sedaghat
- School of MedicineIsfahan University of Medical SciencesIsfahanIran
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Transgastric Drainage for Esophageal Injuries: A Dynamic Strategy for a Heterogenous Patient Cohort. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:54-59. [PMID: 34516474 DOI: 10.1097/sle.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Esophageal injury is a rare but potentially lethal surgical emergency. It is associated with significant morbidity and mortality because of mediastinal contamination and difficulty of access. Surgery in such septic patients exacts a heavy physiological price, mandating consideration of more conservative measures. We review our experience with transgastric drainage for esophageal perforation and high-risk anastomotic dehiscence. PATIENTS AND METHODS A select cohort of patients presenting with esophageal perforation, or complex anastomotic leaks, over 10 years were considered for transgastric drainage (TGD). A modified 36F chest drainage tube was inserted by percutaneous endoscopic gastrostomy technique, either endoscopically or at open surgery, and a negative pressure (-10 cmH2O) was applied until the leak had sealed. Endpoints include, length of stay, restoration of gastrointestinal tract continuity and mortality. RESULTS Of 14 patients treated, 10 had perforations and 4 had complex anastomotic leaks. Ten patients had drainage alone, while 4 required concomitant operative intervention. The median duration of drain insertion for those treated with TGD alone was 19.5 days. Complete restoration of gastrointestinal tract continuity was achieved in all patients. There was no procedure-related morbidity or mortality. CONCLUSION These results show that TGD is a safe and effective management strategy. We advocate its use alone or as an adjunct to operative treatment for esophageal perforation or anastomotic leaks. This is the first report of completely endoscopic TGD for esophageal perforation.
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Andrási L, Paszt A, Simonka Z, Ábrahám S, Erdős M, Rosztóczy A, Ollé G, Lázár G. Surgical Treatment of Esophageal Achalasia in the Era of Minimally Invasive Surgery. JSLS 2021; 25:JSLS.2020.00099. [PMID: 33879995 PMCID: PMC8035823 DOI: 10.4293/jsls.2020.00099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction: We have analyzed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative esophageal function. Patients and Methods: Between January 1, 2008 and December 31, 2017, 54 patients with esophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Forty-eight of the elective cases involved a laparoscopic cardiomyotomy with Dor’s semifundoplication, while two cases entailed an esophageal resection with an intrathoracic gastric replacement for end-stage achalasia. Torek’s operation was performed on two patients for iatrogenic esophageal perforation, and two others underwent primary suture repair with Heller–Dor surgery as an emergency procedure. The results of the different surgical treatments, as well as changes in the patients’ pre- and post-operative complaints were evaluated. Results: No intra-operative complications were observed, and no mortalities resulted. During the 12 to 24-month follow-up period, recurrent dysphagia was observed mostly in the spastic group (TIII: 33%; diffuse esophageal spasm: 60%), while its occurrence in the TI type did not change significantly (14.5%–20.8%). As a result of the follow-up of more than two years, good symptom control was achieved in 93.7% of the patients, with only four patients (8.3%) developing postoperative reflux. Conclusions: The laparoscopic Heller–Dor procedure provides satisfactory long-term results with low morbidity. In emergency and advanced cases, traditional surgical procedures are still the recommended therapy.
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Affiliation(s)
- László Andrási
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Márton Erdős
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - András Rosztóczy
- 1st Department of Internal Medicine, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Georgina Ollé
- 1st Department of Internal Medicine, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary
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Hayashi H, Nagao N, Yamazaki K, Asai R, Tanaka C, Kawai M. Spontaneous esophageal rupture managed with endoscopic closure using an over-the-scope clip: A case report. Int J Surg Case Rep 2021; 80:105691. [PMID: 33640637 PMCID: PMC7933483 DOI: 10.1016/j.ijscr.2021.105691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/04/2021] [Accepted: 02/20/2021] [Indexed: 11/11/2022] Open
Abstract
Spontaneous esophageal rupture is usually treated surgically. However, endoscopic interventions can be performed with good outcomes. Approach is based on degree of infection in the mediastinum and thoracic cavity. We used an over-the-scope clip for esophageal rupture localized to mediastinum. The esophageal perforation was closed once the inflammatory response subsided.
Introduction and importance Spontaneous esophageal rupture is a life-threatening condition caused by a sudden increase in the intraesophageal pressure. While surgery is the mainstay of management for spontaneous esophageal ruptures, in recent years, an increasing number of patients have been managed with endoscopic interventions. We report a case of spontaneous esophageal rupture managed with endoscopic closure using an over-the-scope clip (Ovesco Endoscopy AG, Tübingen, Germany). Case presentation A 68-year-old female presented with epigastric pain and left-sided back pain following vomiting. A computed tomography scan revealed mediastinal emphysema and an esophagogram showed leakage from the left side of the lower thoracic esophagus into the mediastinum. The patient was diagnosed with spontaneous esophageal rupture localized to the mediastinum and was treated conservatively. However, she had persistent fever and continuing esophageal leakage on the esophagogram. On the 12th day of admission, a gastrointestinal endoscopy was performed, which found a 10-mm full-thickness longitudinal laceration on the left side of the lower esophagus. Endoscopic closure using an over-the-scope clip was performed. The next day, the patient became afebrile. One week later, esophagogram revealed slight residual leakage and an additional endoscopic closure using an over-the-scope clip was performed; the patient subsequently had an uneventful recovery and was discharged on the 44th day of admission. Clinical discussion Endoscopic closure using an over-the-scope clip led to a good outcome in this patient with spontaneous esophageal rupture. Conclusion Endoscopic closure using an over-the-scope clip is an effective and minimally invasive technique for selected patients with spontaneous esophageal rupture.
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Affiliation(s)
- Hirokatsu Hayashi
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-City, Gifu-Prefecture, 500-8717, Japan.
| | - Narutoshi Nagao
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-City, Gifu-Prefecture, 500-8717, Japan.
| | - Kenji Yamazaki
- Department of Gastroenterology, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-City, Gifu-Prefecture, 500-8717, Japan.
| | - Ryuichi Asai
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-City, Gifu-Prefecture, 500-8717, Japan.
| | - Chihiro Tanaka
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-City, Gifu-Prefecture, 500-8717, Japan.
| | - Masahiko Kawai
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu-City, Gifu-Prefecture, 500-8717, Japan.
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John A, Chowdhury SD, Kurien RT, David D, Dutta AK, Simon EG, Abraham V, Joseph AJ, Samarasam I. Self-expanding metal stent in esophageal perforations and anastomotic leaks. Indian J Gastroenterol 2020; 39:445-449. [PMID: 33001339 DOI: 10.1007/s12664-020-01078-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Placement of self-expanding metal stents (SEMS) has emerged as a minimally invasive treatment option for esophageal perforation and leaks. The aim of our study was to assess the role of SEMS for the management of benign esophageal diseases such as perforations and anastomotic leaks. METHODS All patients (n = 26) who underwent SEMS placement for esophageal perforation and anastomotic leaks between May 2012 and February 2019 were included. Data were analyzed in relation to the indications, type of stent used, complications, and outcomes. RESULTS Indications for stent placement included anastomotic leaks 65% (n = 17) and perforations 35% (n = 9). Fully covered SEMS (FCSEMS) was placed in 25 patients, and in 1, partially covered SEMS (PCSEMS) was placed. Stent placement was successful in all the patients (n = 26). Four patients did not report for follow-up after stenting. Among the patients on follow-up, 91% (20/22) had healing of the mucosal defect. Stent-related complications were seen in 5 (23%) patients and included stent migration [3], reactive hyperplasia [1] and stricture [1]. CONCLUSION Covered stent placement for a duration of 8 weeks is technically safe and clinically effective as a first-line procedure for bridging and healing benign esophageal perforation and leaks.
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Affiliation(s)
- Anoop John
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | | | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Deepu David
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Vijay Abraham
- Upper GI Surgery Unit, Division of Surgery, Christian Medical College, Vellore 632 004, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Vellore 632 004, India
| | - Inian Samarasam
- Upper GI Surgery Unit, Division of Surgery, Christian Medical College, Vellore 632 004, India
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Paspatis GA, Arvanitakis M, Dumonceau JM, Barthet M, Saunders B, Turino SY, Dhillon A, Fragaki M, Gonzalez JM, Repici A, van Wanrooij RLJ, van Hooft JE. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement - Update 2020. Endoscopy 2020; 52:792-810. [PMID: 32781470 DOI: 10.1055/a-1222-3191] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 : ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3: ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 : ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 : ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.
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Affiliation(s)
- Gregorios A Paspatis
- Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
| | - Marianna Arvanitakis
- Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Jean-Marc Dumonceau
- Gastroenterology Service, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Brian Saunders
- St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
| | | | - Angad Dhillon
- St Mark's Hospital, Wolfson Unit for Endoscopy, North West London Hospitals University Trust, Harrow, London, UK
| | - Maria Fragaki
- Gastroenterology Department, Venizelion General Hospital, Heraklion, Crete-Greece
| | | | - Alessandro Repici
- Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, AG&M Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
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9
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Ranjan SR, Majumdar S, Manickavasagam J, Flach S. Tissue glue: a potential role in the management of intraoperative oesophageal perforation. BMJ Case Rep 2020; 13:13/7/e232568. [PMID: 32737024 DOI: 10.1136/bcr-2019-232568] [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: 11/03/2022] Open
Abstract
An 85-year-old man suffering from oropharyngeal dysphagia due to a pharyngeal pouch and cricopharyngeal spasm underwent endoscopic stapling of the pouch under general anaesthesia. During the procedure, an iatrogenic perforation of the oesophagus was noticed. After considering several options, 5 mL of Tisseel tissue glue was used to seal the perforation intraoperatively. The patient was started on intravenous co-amoxiclav, kept nil by mouth and fed via a nasogastric tube. After 4 days of observation mediastinal collection and any leakage was ruled out with a gastrografin contrast swallow procedure. At this point he was considered safe for oral intake.
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Affiliation(s)
| | | | - Jaiganesh Manickavasagam
- Department of Otorhinolaryngology, Ninewells Hospital, Dundee, UK .,Tayside Academic Science Centre, University of Dundee, Dundee, UK
| | - Susanne Flach
- Otorhinolaryngology and Head & Neck Surgery, Hospital of the Ludwig-Maximilians-University, Munich, Germany
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10
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Esophageal Bronchial Artery Fistulaization: A Complication of an Endobronchial Ultrasound. ACG Case Rep J 2020; 7:e00355. [PMID: 32548187 PMCID: PMC7224716 DOI: 10.14309/crj.0000000000000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
Bronchial artery pseudoaneurysms are an extremely rare cause of upper gastrointestinal bleeding. The presence of a bronchial artery pseudoaneurysm resulting in an esophageal fistula is an entity that, to our knowledge, has yet to be described. Successful management requires an interdisciplinary approach to guide closure of the defects. We present a novel case of an esophageal fistula and bronchial artery pseudoaneurysm resulting from an endobronchial ultrasound-guided transbronchial needle aspiration successfully managed by endoscopic therapy and coil embolization.
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Matsui R, Takayama S, Hattori T, Imagami T, Sakamoto M, Kani H. Iatrogenic esophageal perforation that could be treated indirectly by cervical esophagostomy and laparoscopic surgery. Int J Surg Case Rep 2019; 60:4-7. [PMID: 31185454 PMCID: PMC6556829 DOI: 10.1016/j.ijscr.2019.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/08/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022] Open
Abstract
It is very rare case that each esophageal stump become connected and patent spontaneously. Two-stage surgery is useful for esophageal perforation if radical operation is difficult. Esophageal perforation can be resolved without direct closure if appropriate drainage is performed.
Introduction Successful nonoperative management has been reported for esophageal perforation; however, some cases require surgery. Case presentation We presented the case of an 85-year-old woman with iatrogenic thoracic esophageal perforation in whom primary repair or resection of the perforated esophagus was difficult because she was elderly and had severe aortic valve stenosis. Therefore, we selected a two-stage surgery; laparoscopic gastrostomy, jejunostomy, posterior mediastinal drainage, and cervical esophagostomy were performed. We planned reconstruction after the perforation was closed, but endoscopic examination revealed spontaneous patency of each esophageal stump. Endoscopic balloon dilation was necessary because of esophageal stenosis; however, anastomotic surgery was unnecessary. Conclusion This case report suggests that esophageal perforation is resolved without direct closure if appropriate drainage is performed.
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Affiliation(s)
- Ryohei Matsui
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan.
| | - Satoru Takayama
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Taku Hattori
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Toru Imagami
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Masaki Sakamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
| | - Hisanori Kani
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Japan
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12
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Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, Elgharably H, Vargo PR, Steffen R, Hasan SM, Raja S. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices 2019; 16:197-209. [PMID: 30767693 DOI: 10.1080/17434440.2019.1582329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Historically, the gold standard management of esophageal perforations, leaks, and fistulae has been traditional open surgery, but it is associated with significant morbidity and mortality. Minimally invasive approaches offer alternatives to surgery in treating hemodynamically stable patients with such defects. In this review article, we will discuss the recent advancements in the minimally invasive management of esophageal perforations, leaks, and fistulas. AREAS COVERED This review includes information from case reports, case series, and clinical trials on minimally invasive management of esophageal perforations, leaks, and fistulas. The focus is on the devices, outcomes, and application of the technology. EXPERT COMMENTARY Minimally invasive treatment represents significant progress in the management of esophageal perforations, leaks, and fistulas. Based on current evidence, it seems safe and effective but it is evolving and more studies are needed to help draw definitive conclusions.
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Affiliation(s)
- Shirin Siddiqi
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Dean P Schraufnagel
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Hafiz Umair Siddiqui
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Michael J Javorski
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Adam Mace
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Abdulrhman S Elnaggar
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert Steffen
- b Department of Cardiovascular Surgery , Minneapolis Heart Institute Foundation , Minneapolis , MN , USA
| | - Saad M Hasan
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Siva Raja
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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Burr NE, Everett SM. Management of benign oesophageal strictures. Frontline Gastroenterol 2019; 10:177-181. [PMID: 31205660 PMCID: PMC6540277 DOI: 10.1136/flgastro-2018-101075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Abstract
Benign oesophageal strictures are an important gastrointestinal condition that can cause substantial morbidity. There are many different aetiologies and each case needs careful evaluation and individualised treatment. Management usually involves targeting therapy to the underlying cause, but oesophageal dilatation is an important part of the algorithm. The recent British Society of Gastroenterology guidelines provide advice on the use of dilatation for benign strictures and cover patient preparation, the dilatation procedure and disease-specific considerations. This article provides a summary of the key messages from the guidelines and applies them to routine clinical practice. It also includes practical advice on the clinical assessment, investigation and management of benign oesophageal strictures and gives an approach to the management of refractory strictures. Areas where evidence is sparse and further research is needed are highlighted.
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Affiliation(s)
- Nicholas E Burr
- Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, UK,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Simon M Everett
- Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, UK
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Still S, Mencio M, Ontiveros E, Burdick J, Leeds SG. Primary and Rescue Endoluminal Vacuum Therapy in the Management of Esophageal Perforations and Leaks. Ann Thorac Cardiovasc Surg 2018; 24:173-179. [PMID: 29877217 PMCID: PMC6102603 DOI: 10.5761/atcs.oa.17-00107] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To investigate the efficacy of primary and rescue endoluminal vacuum (EVAC) therapy in the treatment of esophageal perforations and leaks. METHODS We conducted a retrospective review of a prospectively gathered, Institutional Review Board (IRB) approved database of EVAC therapy patients at our center from July 2013 to September 2016. RESULTS In all, 13 patients were treated for esophageal perforations or leaks. Etiologies included iatrogenic injury (n = 8), anastomotic leak (n = 2), Boerhaave syndrome (n = 1), and bronchoesophageal fistula (n = 2). In total, 10 patients underwent primary treatment and three were treated with rescue therapy. Mean Perforation Severity Scores (PSSs) in the primary and rescue treatment groups were 7 and 10, respectively. Average defect size was 2.4 (range: 0.5-6) cm. The rescue group had a shorter mean time to defect closure (25 vs. 33 days). In all, 12 of 13 defects healed. One death occurred following the implementation of comfort care. One therapy-specific complication occurred. Hospital length of stay (LOS) was longer in the rescue group (72 vs. 53 days); however, the intensive care unit (ICU) duration was similar between groups. Totally, 10 patients (83%) resumed an oral diet after successful defect closure. CONCLUSION Utilized as either a primary or rescue therapy, EVAC therapy appears to be beneficial in the management of esophageal perforations or leaks.
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Affiliation(s)
- Sasha Still
- Department of Surgery, Baylor University Medical Center at Dallas, Texas, USA
| | - Marissa Mencio
- Department of Surgery, Baylor University Medical Center at Dallas, Texas, USA
| | | | - James Burdick
- Department of Gastroenterology, Baylor University Medical Center at Dallas, Texas, USA
| | - Steven G Leeds
- Division of Minimally Invasive Surgery, Baylor University Medical Center at Dallas, Texas, USA
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An Endoscopic Nasomediastinal Approach to a Mediastinal Abscess Developing after Zenker's Diverticulectomy. Case Rep Gastrointest Med 2017; 2017:8726706. [PMID: 28831318 PMCID: PMC5558635 DOI: 10.1155/2017/8726706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/04/2017] [Indexed: 11/17/2022] Open
Abstract
Zenker's diverticulum is the most frequent symptomatic diverticulum of the esophagus, but the prevalence is <0.1%. The optimal treatment is surgery. Here, we present a nasomediastinal drainage approach to treatment of a mediastinal abscess, developing in the late postoperative period and attributable to leakage from the staple line.
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Privezentsev SA, Rozovskiy MI, Temirsultanov RY, Smolyar AN. [Endoscopic clipping of esophageal rupture]. Khirurgiia (Mosk) 2016:83-85. [PMID: 27905379 DOI: 10.17116/hirurgia20161183-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - A N Smolyar
- Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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