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Timing of esophageal stent placement and outcomes in patients with esophageal perforation: a single-center experience

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Abstract

Background

Endoscopic treatment for esophageal perforation with stenting is an alternative to surgery. There is no data on the impact of timing of esophageal stent placement and outcomes in patients with esophageal perforation.

Objective

To determine the significance of timing of esophageal stent placement on short-term (30-day complications) and long-term clinical outcomes of patients with esophageal perforation.

Methods

Patients with esophageal perforations who underwent endoscopic treatment with stenting from 2007 to 2012 at the Cleveland Clinic were included for the study. Main outcomes measurements were impact of time to esophageal stent placement on 30-day complications and long-term outcomes.

Results

A total of 20 patients (males 40 % and females 60 %) were included. Mean age was 72.5 ± 10 years. The most common etiology for perforation was iatrogenic after endoscopy procedure in 10 (50 %) patients. The stent was in place for a median of 24.6 days in our cohort. Eight patients (40 %) had stent placement within 24 h, while the remaining 12 patients (60 %) had stent placement after 24 h. The mortality rate due to perforation related causes was 10 % (2/20) in our study. The 30-day complication rate was 10 %; 1 with stent migration and the other with chest pain. The 30-day readmission rates excluding patients who died during the initial hospitalization were 10 %. On long-term follow-up, 30 % complication rates were encountered; 3 (15 %) stent migrations, 2 (10 %) patients presented with hematemesis, and 1 (5 %) with chest pain. The timing of stent placement (within 24 h or later) did not impact the risk of complications (Odds Ratio [OR] 1.13, 95 % confidence interval 0.1–8.9, P = 0.91).

Conclusions

Endoscopic stent placement is safe and effective for treating esophageal perforations. However, the timing of stent placement on outcomes remains unclear.

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Abbreviations

CCI:

Charlson comorbidity index

ASA:

American Society of Anesthesiologists physical classification

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Acknowledgment

We thank Rajesh Konjeti MD for help with statistical analysis.

Disclosures

Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Sudhir Duvuru, Dennisdhilak Lourdusamy, Dhruv Mehta, Siva Raja, Sudhish Murthy, and Madhusudhan R. Sanaka have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH, USA

    Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Sudhir Duvuru, Dennisdhilak Lourdusamy, Dhruv Mehta & Madhusudhan R. Sanaka

  2. Heart and Vascular Surgery Institute, The Cleveland Clinic, Cleveland, OH, USA

    Siva Raja & Sudhish Murthy

  3. Digestive Disease Institute-Desk Q3, The Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA

    Madhusudhan R. Sanaka

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  1. Udayakumar Navaneethan
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  2. Vennisvasanth Lourdusamy
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Correspondence to Udayakumar Navaneethan.

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Navaneethan, U., Lourdusamy, V., Duvuru, S. et al. Timing of esophageal stent placement and outcomes in patients with esophageal perforation: a single-center experience. Surg Endosc 29, 700–707 (2015). https://doi.org/10.1007/s00464-014-3724-2

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