Document Detail


Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents.
MedLine Citation:
PMID:  16427833     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Spontaneous or iatrogenic esophageal perforations after endoscopic procedures are potentially life-threatening events with a considerable mortality rate. The aim of this study was to demonstrate that a nonoperative endoscopic treatment with self-expanding metal stents may have a lower morbidity and mortality rate compared with surgical treatment. METHODS: A nonrandomized observational study was conducted with 15 consecutive patients between January 1997 and June 2004. Benign spontaneous and iatrogenic esophageal perforations after endoscopic procedures were treated with self-expandable metal stents. RESULTS: Seven patients (group 1) underwent stent insertion with an average time delay of 45 minutes. In 8 patients (group 2), the median delay was 123 hours. All patients in group 1 had an uneventful recovery and left hospital 5 days (range, 3 to 9) after stent insertion. One patient in group 2 (1 of 8) died of pneumonia after 6 days. In any other cases, perforations healed successfully after stent placement, but the clinical course was generally complicated with sepsis and multiple organ failure. The average hospital stay was 44 days (range, 15 to 70). CONCLUSIONS: Immediate insertion of a self-expandable metal stent enables an excellent outcome with minimal mortality and morbidity without the need for operation. Even in cases of old esophageal perforations, sealing with self-expandable metal stents is still a good option although the clinical course is much less impressive than in early treated perforations.
Authors:
Andreas Fischer; Oliver Thomusch; Stefan Benz; Ernst von Dobschuetz; Peter Baier; Ulrich T Hopt
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  81     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-23     Completed Date:  2006-08-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  467-72     Citation Subset:  AIM; IM    
Affiliation:
Department of General and Visceral Surgery, Albert-Ludwigs-University, Freiburg, Germany. andreas.fischer@uniklinik-freiburg.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Endoscopy, Gastrointestinal
Esophageal Perforation / complications*,  etiology,  therapy*
Female
Humans
Iatrogenic Disease
Length of Stay
Male
Middle Aged
Multiple Organ Failure / etiology
Prosthesis Design
Sepsis
Stents*
Treatment Outcome
Wound Healing
Comments/Corrections
Comment In:
Ann Thorac Surg. 2006 Feb;81(2):472-3   [PMID:  16427834 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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