Esophageal perforation: Continuing challenge to treatment

Publication date: June 2013 Source:Gastrointestinal Intervention, Volume 2, Issue 1 Author(s): Ronald V. Romero , Khean-Lee Goh Esophageal perforation carries with it a high morbidity and mortality if not treated appropriately and aggressively. Three approaches are available for the treatment of esophageal perforation: conservative, endotherapy, and surgery. The location viz. cervical, thoracic, or abdominal portions of the esophagus and size of the perforation influence treatment choice. Cervical perforations are usually small and can be treated conservatively as the perforation or leak is also contained within the triangle of Killian in the neck. Most cervical perforations have a good outcome with conservative treatment with intravenous antibiotics and nil by mouth. Treatment of thoracic perforations depends very much on the size of the perforation. Small perforations due to sclerotherapy injection, for example, can be treated conservatively. Endotherapy can help avoid surgery in other cases: small tears from endoscopic insertion can be clipped and esophageal fistulae can be injected with fibrin glue. Larger perforations can be treated with stent placement if the dehiscence of the lumen circumference does not exceed 70%. Stent placement with self-expandable fully-covered plastic and metallic stents or partially-covered metallic stents has been used with fairly good success. One of the problems with stent placement is the migration of these stents. Perforation of the i...
Source: Gastrointestinal Intervention - Category: Gastroenterology Source Type: research