Minimally invasive treatment of esophageal perforation using a multidisciplinary treatment algorithm: a case series

Abstract

Esophageal perforation is a dreaded condition with high morbidity and mortality rates. The diagnosis often depends on clinical suspicion, features, and radiographic or endoscopic testing confirming an esophageal leak. The most common cause of esophageal perforation is secondary to an iatrogenic injury but it can also be the result of spontaneous perforation, chemical or foreign body ingestion, and penetrating trauma. Hence, due to mortality rates as high as 20 %, a high index of suspicion and established treatment algorithms are paramount [ 1 ]. Based on our institution’s reported aggressive conservative therapy in patients with esophageal perforations resulting in lower morbidity and mortality while avoiding major clinical experience surgery [ 2 ], and the various applications of endoluminal products [ 3 ] [ 4 ] [ 5 ] [ 6 ], our approach to the treatment of esophageal perforations has been revised with the development of a treatment algorithm. The hypothesis behind the algorithm is that endoscopic placement of fully covered self expandable removable esophageal stents together with aggressive conservative therapy is an effective method of treatment for patients with esophageal perforations, and results in low morbidity and mortality without the need for surgical intervention [ 7 ]. In addition, the utilization of an endoscopically placed removable covered stent also results in rapid leak occlusion, and a decrease in posterior mediastinal contamination, morbidity, and hospital stay. This type of modality enables the treatment of esophageal perforations in patients with significant co-morbidities and elderly patients who are often not suitable or hemodynamically stable enough for surgical intervention.