ORIGINAL ARTICLE   

Minerva Gastroenterologica e Dietologica 2019 September;65(3):193-9

DOI: 10.23736/S1121-421X.19.02587-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Endoscopic therapy compared to surgical repair for the treatment of acute esophageal perforations

Sharareh MORAVEJI ¹✉, Douglas G. ADLER ², Andrew DARGAN ³, Shayan MORAVEJI ³, Idean POURSHAMS ³, Ali SIDDIQUI ³

¹ Texas Tech University Health Sciences Center, El Paso, TX, USA; ² Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA; ³ Department of Gastroenterology and Hepatology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

BACKGROUND: There is currently limited long-term data regarding the clinical outcomes of endoscopic stents as an alternative for emergency surgery in the treatment of acute esophageal perforation. Our aim was to compare the long-term outcomes of endoscopic stenting with those of surgery for patients with acute esophageal perforation.
METHODS: We performed a retrospective study of acute esophageal perforation patients who underwent insertion of esophageal stents (N.=80) or surgery (N.=85) for treatment. The primary endpoint was technical and clinical success to resolve esophageal perforation. Secondary endpoints include early (procedural) and long-term adverse event, acute mortality, and hospital stay duration.
RESULTS: Technical success was achieved in 78% of patients treated with stent, and 90.6% of patients who underwent surgery. Clinical success to resolve perforation was 88.7% of patients with stent placement and 95.3% in the surgery group (P=0.15). Stent patients had significantly less procedural adverse events compared to the surgery group (3.8% vs. 15%, P=0.0001). The acute mortality for the stent group was 2.5% compared to 3.5% in surgery group (P=0.6). Patients in the stent group had shorter median hospital stay (22 days) as compared to the surgery group (32 days) (P<0.00001). Stent placement was associated with higher long-term complication rates as compared to surgery (31.2% vs. 10.6%, P=0.0001). Patients who underwent surgery had a significantly higher mortality (10.6%) compared to stent group (2.5%) (P=0.05).
CONCLUSIONS: Technical and clinical success for acute esophageal perforation therapy were similar among patients who underwent placement of stents as compared to surgery. Surgery was associated with a higher mortality, longer hospital stay and a markedly higher rate of procedural adverse events. Esophageal stents may be considered as the initial mode of therapy of a patient with acute esophageal perforation.

KEY WORDS: Esophageal perforation; Stents; Surgery