Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation

Background. Iatrogenic esophageal perforation after endoscopy or surgery can be a devastating event. Traditional therapy has most often consisted of operative repair of the esophagus. This investigation summarizes our experiences treating iatrogenic intrathoracic perforations of the esophagus using an occlusive removable esophageal stent. Methods. Over a 24-month period, patients found to have an iatrogenic intrathoracic esophageal perforation at a tertiary care medical center were offered endoluminal esophageal stent placement instead of operative repair of the esophagus as initial therapy. Excluded were patients with an esophageal malignancy or a chronic esophageal fistula. Silicone-coated stents were placed endoscopically utilizing general anesthesia and fluoroscopy. Adequate drainage of infected areas was also simultaneously achieved. Leak occlusion was confirmed by esophagram. Patients were followed until their stent was removed and their esophageal leak had resolved. Results. Seventeen patients had 18 esophageal stents placed for acute perforations of the esophagus after endoscopy ( 8) or surgery ( 9) during the study period. Associated endoscopic ( 13) or surgical procedures ( 7) were performed simultaneously in all 17 patients. Leak occlusion occurred in 16 patients (94%) as confirmed by esophagram. Fourteen patients (82%) were able to initiate oral nutrition within 72 hours of stent placement. One patient (6%) experienced a continued leak after stent placement and underwent operative repair. Stent migration requiring repositioning ( 2) or replacement ( 2) occurred in 3 patients (18%). All stents were removed at a mean of 52 +/- 20 days after placement. Hospital length of stay for patients treated with esophageal stent placement was 8 +/- 9 days ( median, 5). Conclusions. Endoluminal esophageal stent placement is an effective method for the treatment of acute, iatrogenic perforations of the intrathoracic esophagus. These stents result in rapid leak occlusion, provide the opportunity for early oral nutrition, may significantly reduce hospital length of stay, are removable, and avoid the potential morbidity of operative repair.