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

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

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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