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Surgical Endoscopy

, Volume 29, Issue 4, pp 987–991 | Cite as

Iatrogenic pharyngoesophageal perforations treated with fully covered self-expandable metallic stents (with video)

  • Vivek Kumbhari
  • Alba A. Azola
  • Alan H. Tieu
  • Reetika Sachdeva
  • Payal Saxena
  • Ahmed A. Messallam
  • Mohamad H. El Zein
  • Patrick I. OkoloIII
  • Mouen A. KhashabEmail author
Dynamic Manuscript

Abstract

Background

Iatrogenic pharyngoesophageal perforations are a rare but serious complication of endoscopy. Surgical and non-surgical approaches have been reported but result in a significant morbidity and extended hospital stay. Therefore, an unmet need exists for an alternative management technique. We demonstrate a new endoscopic approach for the management of iatrogenic pharyngoesophageal perforations through the use of esophageal fully covered self-expandable metallic stents (FCSEMS).

Patients and methods

Two patients who underwent flexible endoscopy each suffered a large iatrogenic perforation detected intraprocedurally. After emergency intubation, an esophageal FCSEMS was deployed in the hypopharynx and the patient admitted to the intensive care unit. On day 3, the patients underwent an esophagogastroduodenoscopy with stent removal.

Results

There was complete closure of the perforations on day 3. The patients were extubated and subsequently tolerated a soft diet. The patients were discharged home on day 4.

Conclusions

The placement of a removable FCSEMS in the setting of an acutely diagnosed perforation may be a suitable minimally invasive approach for the management of iatrogenic pharyngoesophageal perforations.

Keywords

Perforation Fully covered self-expandable metallic esophageal stent Hypopharynx Pharyngoesophageal 

Abbreviations

FCSEMS

Fully covered self-expandable metallic stents

EGD

Esophagogastroduodenosopy

ICU

Intensive care unit

CT

Computed tomography

OTSC

Over-the-scope clip

UES

Upper esophageal sphincter

ENT

Ear, nose and throat

Notes

Disclosures

Mouen A. Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. Payal Saxena has received consulting fees from Boston Scientific and has received research support from Cook Medical. All other authors have no relevant disclosures.

Supplementary material

Endoscopic view of the overtube induced perforation and deployment of the esophageal fully covered self-expandable metallic stent. Endoscopy with stent removal on day 3 demonstrates complete closure of the perforation. (MP4 62331 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Vivek Kumbhari
    • 1
  • Alba A. Azola
    • 1
  • Alan H. Tieu
    • 1
  • Reetika Sachdeva
    • 1
  • Payal Saxena
    • 1
  • Ahmed A. Messallam
    • 1
  • Mohamad H. El Zein
    • 1
  • Patrick I. OkoloIII
    • 1
  • Mouen A. Khashab
    • 1
    Email author
  1. 1.Department of Medicine and Division of Gastroenterology and HepatologyThe Johns Hopkins Medical InstitutionsBaltimoreUSA

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