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Review
. 2017 Mar;9(Suppl 2):S135-S145.
doi: 10.21037/jtd.2017.03.100.

Endoscopic management of esophageal leaks

Gabie K B Ong  1 , Richard K Freeman  2
Affiliations
Review

Endoscopic management of esophageal leaks

Gabie K B Ong et al. J Thorac Dis. 2017 Mar.

Abstract

Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents. Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse complications. This review summarizes the modern history of esophageal stent use in the treatment of esophageal perforation as well as the evidenced based recommendations for the use of esophageal stent placement in the treatment of acute esophageal perforation.

Keywords: Esophageal perforation; esophageal fistula; esophageal stent.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Treatment algorithm for esophageal perforation.
Figure 2
Figure 2
Contrast esophagram displaying a mid-thoracic esophageal perforation.
Figure 3
Figure 3
Computer aided tomographic imaging of the chest following an esophageal perforation.
Figure 4
Figure 4
Endoscopic view of an acute esophageal perforation.
Figure 5
Figure 5
Fluoroscopic image of an esophageal stent placement for acute perforation.
Figure 6
Figure 6
Esophagram 48 hours after esophageal stent placement for acute perforation.
See this image and copyright information in PMC

References

    1. Symonds CJ. The treatment of malignant stricture of the oesophagus by tubage or permanent catheterism. Br Med J 1887;1:870-3. 10.1136/bmj.1.1373.870 - DOI - PMC - PubMed
    1. Guisez J. De l’intubation caouchoutee oesophienne. Presse Med 1914;22:85.
    1. Souttar HS. A method of intubating the esophagus for malignant stricture. Br Med J 1924;1:782-3. 10.1136/bmj.1.3305.782 - DOI - PMC - PubMed
    1. Coyas A. Palliative intubation in carcinoma of the oesophagus. Lancet 1955;269:647-9. 10.1016/S0140-6736(55)92485-5 - DOI - PubMed
    1. Mousseau M, Le Forestier J, Barbin J. Role of permanent intubation in palliative treatment of esophageal cancer. Arch Mal Appar Dig Mal Nutr 1956;45:208-14. - PubMed

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