TITLE:
Iatrogenic Oesophageal Perforations in Neoplastic Lesions: Management with Covered Self-Expanding Prostheses
AUTHORS:
Mario Anselmi Mendez, Ana MarÍA Gemmato Pascazio, Maximiliano Figueroa Silva, Julio Salgado OyarzÚN
KEYWORDS:
Iatrogenic Oesophageal Perforations, Self-Expanding Prostheses, Oesophageal Cancer
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.11 No.6,
June
30,
2021
ABSTRACT: Background:Perforation of the
oesophagus is a serious condition. Most of them are iatrogenic and are
associated with significant morbidity and mortality, especially with late
diagnosis. Aim: To prospectively analyse the results of the endoscopic
management of iatrogenic perforations in oesophageal neoplasia, through the
immediate insertion of a covered self-expanding prosthesis (CSES). Materials
and Methods: Between 01.01.2006 and 12.30.2016, a series of 19 consecutive
patients attended the Teaching Unit of Endoscopic Surgery of the Regional de
Concepción Hospital, Chile, with the diagnosis of oesophageal neoplasia
confirmed by biopsy were prospectively studied. All were subjected to a prior
evaluation by the oncology team and subsequently referred for endoscopic palliative
management of dysphagia. The average age was 77 ± 9.3 years, 8 (42.1%) were
female and 11 (57.9%) were male. In 17 patients (89.5%) the stenosis
compromised the oesophagus, in 2 (10.5%) the gastro-oesophageal junction, 16
had a squamous carcinoma (84.2%) and 3 an adenocarcinoma (15.8%). Results: Perforation
was diagnosed during the procedure in 18 patients (94.7%) and in 1 (5.3%) 22
hours later. Follow-up was done for a minimum of 90 days or until death. The
prostheses were inserted successfully in all cases. The immediate evolution was
satisfactory in 12 patients (63.2%). In the rest (36.8%), 18 complications
appeared. The most frequent were retrosternal pain, subcutaneous emphysema and
fever. The early evolution was satisfactory in 12/19 cases (63.2%). Complication
was evidenced in 7 (36.8%), the most frequent was retrosternal pain (36.8%).
Fever occurred in 3 (15.8%), pleural effusion in 3 (15.8%) and mediastinitis in
2 of these. The prosthesis was kept in situ as a definitive palliation method
for neoplastic dysphagia. In 10 of the 18
cases that survived more than a month, there were late complications (55.6%),
none of them associated with the perforation itself. The only death (5.3%) was
due to an oesophagus-pleural fistula, associated with an early prosthetic
migration. Recovery of the oral intake occurred, on average, at 3.7 days. The
hospital stay averaged 9.6 days. Conclusion: The use of CSES for the
treatment of iatrogenic oesophageal perforations in the context of neoplasia,
is a safe and effective method, with low morbidity, adequate recovery of the
oral intake and prompt discharge from hospital.