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

• Published in: Surgical endoscopy Vol. 29; no. 4; pp. 987 - 991
• Main Authors: Kumbhari, Vivek, Azola, Alba A., Tieu, Alan H., Sachdeva, Reetika, Saxena, Payal, Messallam, Ahmed A., El Zein, Mohamad H., Okolo, Patrick I., Khashab, Mouen A.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-04-2015; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Antibiotics; Digestive System Surgical Procedures - methods; Dynamic Manuscript; Endoscopy; Esophagus; Esophagus - injuries; Extubation; Female; Gastroenterology; Gynecology; Hepatology; Humans; Iatrogenesis; Iatrogenic Disease; Intensive care; Intubation; Male; Medicine; Medicine & Public Health; Middle Aged; Patients; Pharyngeal Diseases - etiology; Pharyngeal Diseases - surgery; Pharynx - injuries; Proctology; Prosthesis Implantation - methods; Reoperation; Rupture; Sinuses; Stents; Surgeons; Surgery; United States > US; Hypopharynx; Fully covered self-expandable metallic esophageal stent; Perforation; Pharyngoesophageal
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-014-3767-4

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.