Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Feb;7(1):23-27.
doi: 10.14740/gr593w. Epub 2014 Mar 14.

Combined Placement of Covered Self-Expanding Metallic Stents and Nasojejunal Tube for Managing Large Lower Esophageal Perforations

Surinder S Rana  1 , Rajesh Gupta  2 , Divya Dahiya  2 , Arunanshu Behera  2 , Deepak K Bhasin  1
Affiliations
Case Reports

Combined Placement of Covered Self-Expanding Metallic Stents and Nasojejunal Tube for Managing Large Lower Esophageal Perforations

Surinder S Rana et al. Gastroenterology Res. 2014 Feb.

Abstract

Covered self-expanding metallic stents (cSEMSs) have emerged as effective treatment option for esophageal perforations. However, the large lower esophageal perforations where the cSEMS is placed across gastroesophageal junction have lower healing rates because refluxed gastric contents constantly irritate perforation and also there is increased risk of stent migration. Moreover, gastric mucosa tends to prolapse into lumen of lower end of stent causing its obstruction, leading to seepage of saliva and fluids from upper end of stent even in the patients who are on parenteral nutrition. We present our experience of a novel technique of combined cSEMS and nasojejunal tube (NJT) placement in four patients (two males) with benign large lower esophageal perforations. The NJT was placed through the stent into the jejunum through which patients were given enteral feeding. The stents were placed 5 - 21 days after esophageal perforation with the size of perforation ranging from 4 to 6 cm. As the NJT formed a loop in stomach, it prevented migration of stent. And also its presence in lumen of stent prevented its obstruction by prolapsing gastric mucosa, thereby preventing seepage of saliva and fluids from side of stent. Both stents and NJT were removed after 6 weeks and leak closed in all patients. Combined cSEMS and NJT placement seems to be safe and effective for treating large lower esophageal perforations. NJT placement seems to decrease risk of migration, prevents seepage of fluids and permits early enteral nutrition, thereby improving the healing rates.

Keywords: Bariatric surgery; Esophagus; Leaks; Stents.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Contrast study of esophagus: no contrast is seen going across the lower end of stent. Contrast is seen seeping along the sides of the SEMS (black arrow) and then leaking into pleural cavity (white arrow). A pigtail is seen inside the left pleural cavity.
Figure 2
Figure 2
Lower end of SEMS blocked by prolapsed gastric mucosa.
Figure 3
Figure 3
Endoscopy done 3 weeks after placement of NJT. The NJT is seen going through the SEMS and lower end of SEMS is seen opened up.
Figure 4
Figure 4
Large perforation at lower end of esophagus.
Figure 5
Figure 5
NJT is seen passing through SEMS into the jejunum. Pigtail in left pleural cavity and central line catheter are also noted.
Figure 6
Figure 6
NJT placed through the SEMS.
Figure 7
Figure 7
Endoscopy after stent removal: small depression is noted at the site of perforation.
Figure 8
Figure 8
Contrast study after stent removal: no leakage of contrast is seen and a small outpouching is seen at site of perforation (arrow).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Adamek HE, Jakobs R, Dorlars D, Martin WR, Kromer MU, Riemann JF. Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy. Scand J Gastroenterol. 1997;32(5):411–414. doi: 10.3109/00365529709025073. - DOI - PubMed
    1. Jougon J, Delcambre F, MacBride T, Minniti A, Velly JF. [Mortality from iatrogenic esophageal perforations is high: experience of 54 treated cases] Ann Chir. 2002;127(1):26–31. doi: 10.1016/S0003-3944(01)00660-5. - DOI - PubMed
    1. Swinnen J, Eisendrath P, Rigaux J, Kahegeshe L, Lemmers A, Le Moine O, Deviere J. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–899. doi: 10.1016/j.gie.2010.12.019. - DOI - PubMed
    1. Bufkin BL, Miller JI Jr, Mansour KA. Esophageal perforation: emphasis on management. Ann Thorac Surg. 1996;61(5):1447–1451. discussion 1451-1442. - PubMed
    1. Freeman RK, Ascioti AJ, Wozniak TC. Postoperative esophageal leak management with the Polyflex esophageal stent. J Thorac Cardiovasc Surg. 2007;133(2):333–338. doi: 10.1016/j.jtcvs.2006.10.008. - DOI - PubMed

Publication types

LinkOut - more resources