PS01.089: A DIFFERENT FIXATION METHOD TO PREVENT STENT MIGRATION IN ESOPHAGEAL FISTULAS AND PERFORATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 75-75
Author(s):  
Atila Eroglu ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Omer Yilmaz
Keyword(s):  
Esophageal Perforation ◽  
Suture Material ◽  
Conflicts Of Interest ◽  
Flexible Endoscopy ◽  
Stent Migration ◽  
Suture Technique ◽  
Esophageal Stent ◽  
Fixation Method ◽  
High Morbidity ◽  
Delivery Catheter

Abstract Background Esophageal perforation is an emergency condition characterized by high morbidity and mortality. The removable esophageal stent is an effective method of treatment in cases with esophageal perforation as they allow minimal invasive and rapid nutrition. Stent migration is an important problem in perforations and fistulas where there is no obstruction in the esophageal lumen. Several methods are used to prevent stent migration, including different stent types and endoscopic suture technique. In this study, we aimed to present a method that we use in our clinic to prevent stent migration. Methods We retrospectively evaluated 12 consecutive patients who underwent stent placement and were fixed for migration prevention for esophageal fistula or perforation between January 2013 and February 2018 in our clinic. All of the cases were self-expandable metallic stents. The stent was removed from the delivery catheter without insertion and the suture material was passed through the head and reattached to the catheter. The stent was placed using flexible endoscopy. The suture material placed on the upper part of the stent was taken out of the mouth of the patient. After the stent is inserted and the delivery catheter is removed, the nasal catheter (aspiration catheter) was inserted and removed from the mouth. The suture material in the mouth was connected to the tip of the aspiration catheter. The aspiration catheter was withdrawn. The suture material removed from the patient's nose was fixed like a nasogastric catheter. After 3 or 4 days from the procedure, the suture was cut. Migration of the stent was followed by direct radiography. Results Seven cases were female and five cases were male. The mean age was 51.1 ± 12.7 years (range 20–72 years). No migrations were observed in any of the cases. After a mean of 19.5 days (range 11–23 days), the stent was removed endoscopically. In all cases, perforation and fistula improved. Conclusion We think that the esophageal stent fixation method is a simple and effective method to prevent migration. Disclosure All authors have declared no conflicts of interest.

PS01.037: APPLYING THORACIC ENDOVASCULAR AORTIC REPAIR (TEVAR) AND SURGICAL RESECTION WITH RECONSTRUCTION OF ESOPHAGUS IN MANAGING OF AORTA-ESOPHAGEAL FISTULA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 60-60
Author(s):  
Yi-Pin Chou ◽  
Hsing-Lin Lin
Keyword(s):  
Hemorrhagic Shock ◽  
Esophageal Perforation ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Oral Intake ◽  
Acute Stage ◽  
Esophageal Stent ◽  
Thoracic Esophagus ◽  
Esophageal Fistula ◽  
Subtotal Esophagectomy

Abstract Background Aorta-esophageal fistula (AEF) is very dangerous with high mortality. Treatment is difficult because of hemorrhagic shock in acute stage and infection in sub-acute stage. We develop a method to manage both perforations from aorta and esophagus successfully. Methods A 56 male patient had fish bone incarcerated in thoracic esophagus. Two months after this accident, intermittent massive hematemesis occurred. The esophagoscopy displayed active bleeding and AEF was diagnosed by computed tomography angiography (CTA). TEVAR is applied immediately and stopped bleeding successfully. Fever with sepsis and mediastinitis was happened after oral intake. The perforated esophagus was removed by wire-stripper through neck and abdomen incisions and reconstructed with gastric tube via retro-sternal route. Results After subtotal esophagectomy with gastric tube reconstruction, the ventilator is weaned and endotracheal tube was removed. No leakage from anastomosis between cervical esophagus and gastric tube. Patient could swallow regular diet smoothly. No further post-operative complication was happened after follow up two years. Conclusion TEVAR is the first step in managing AEF in acute stage to prevent hemorrhagic shock. Although esophageal perforation could be managed with esophageal stent, the marginal ulcer with pain and bleeding may cause other side effects. Esophageal stent is also another contra-indication applied in benign disease. Subtotal esophagectomy with wire-stripper and reconstruction with gastric tube could provide definite treatment for this esophageal perforation. Disclosure All authors have declared no conflicts of interest.

scholarly journals Successful conservative treatment of spontaneous intrathoracic esophageal perforation using a temporary covered esophageal stent with a check valve: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Ryu Matsumoto ◽  
Ken Sasaki ◽  
Itaru Omoto ◽  
Masahiro Noda ◽  
Yasuto Uchikado ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pleural Effusion ◽  
Conservative Treatment ◽  
Esophageal Perforation ◽  
Elemental Diet ◽  
Tension Pneumothorax ◽  
Check Valve ◽  
Esophageal Stent ◽  
Surgical Trauma ◽  
High Morbidity

Abstract Background Spontaneous esophageal perforation is a potentially life-threatening condition with high morbidity and mortality rates. While surgical treatment has been employed for esophageal perforation, we have adopted conservative treatment with an esophageal stent for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients. Case presentation A 60-year-old male complaining of left chest and back pain after vomiting was transferred to a local hospital. Computed tomography and chest X-ray examinations showed left tension pneumothorax, pneumomediastinum, and bilateral pleural effusion suspicious of spontaneous intrathoracic esophageal perforation. He was transferred to our hospital for further treatment. After arrival, he developed septic shock with acute respiratory failure. We considered that surgical treatment was too invasive and chose conservative treatment with an esophageal stent. Under general anesthesia, we first inserted a 20-Fr. trocar in the left posterior pleural space, and a large volume of the dark pleural effusion was discharged. We then performed endoscopy and found a pinhole perforation in the left posterolateral wall of the lower esophagus. We inserted both a silicon-covered esophageal stent with a check valve and a double elemental diet (W-ED) tube. We then inserted an 18-Fr. trocar into the left anterior wall. These procedures were performed less than 24 h after onset. As intensive medical care, the patient was administered broad-spectrum antibiotics and catecholamine. The two trocars and the W-ED tube were under continuous suction at − 5 cmH2O and at − 20 cmH2O every 30 s. On the 6th day, we inserted an additional thoracic drainage tube into the left pleura under CT guidance. The patient was discharged from the ICU to the general ward on the 7th day. We removed the stent almost triweekly, and the esophageal perforation was completely healed on the 45th day. He was discharged home on the 70th day. Conclusion Conservative treatment with a temporary self-expanding covered stent with a check valve, sufficient drainage, and W-ED tube nutrition was useful and effective in this unstable case of spontaneous intrathoracic esophageal perforation.

FA07.02: ESOPHAGEAL PERFORATION: A RETROSPECTIVE, SINGLE CENTER OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 13-14
Author(s):  
Balazs Kovacs ◽  
Takahiro Masuda ◽  
Ross Bremner ◽  
Michael Smith ◽  
Jasmine Huang ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Retrospective Chart Review ◽  
Esophageal Resection ◽  
High Morbidity ◽  
Single Center ◽  
Tertiary Referral Hospital ◽  
Exclusion Criteria ◽  
Icu Stay

Abstract Background Esophageal perforation (EP) though uncommon has high morbidity and mortality. Aim of this study is to evaluate the outcomes at a tertiary referral hospital. Methods After IRB approval patients with EP between May 2014 and Sept 2017 were identified. Retrospective chart review was done to collect data. Exclusion criteria were: age under 18, leak following esophageal resection and esophageal stenting in previous year. Pittsburgh esophageal perforation severity score (PS) was calculated for each patient. Results During study period 56 patients (70% men) with EP met inclusion and exclusion criteria with a mean age and BMI of 60 Yrs. 27.1 kg/m2 respectively. Most common causes were iatrogenic (43%) and Boerhaave's (21%). Nearly 3/4th patients presented to the hospital within 24h of onset. The site of perforation was thoracic (67.9%), cervical (16.1%) and abdominal (16.1%). Overall mortality within 1 month was 5.7% (3 cases) compared to predicted (5.8 cases, 10.4%) based on Pittsburgh score (P > 0.05). See Table 1 for PS at presentation, management and ICU stay. Conclusion In our single center experience the leading cause of EP are iatrogenic injury and Boerhaave's syndrome. PS correlated well with need for aggressive surgical intervention and length of ICU stay. Use of endoluminal stents was higher than previously reported. Stents with or without additional surgical intervention can be a viable option in a subset of patients. Disclosure All authors have declared no conflicts of interest.

806 CERVICAL ESOPHAGEAL PERFORATION: MULTIMODAL APPROACH TO A RARE AND MORBID CONDITION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Chee Chuan Tang ◽  
Kelvin Voon ◽  
Nagalingam Premnath
Keyword(s):  
Esophageal Perforation ◽  
Treatment Options ◽  
High Morbidity ◽  
Contrast Study ◽  
Oral Contrast ◽  
Multimodal Approach ◽  
Early Management ◽  
Iatrogenic Perforation ◽  
Diagnosis And Management ◽  
Cervical Esophageal Perforation

Abstract   Cervical esophageal perforation (CEP) is an uncommon but serious surgical condition. It is associated with a high morbidity and mortality if not managed timely, partly due to its close proximity with vital structures in the neck and mediastinum. The common causes include trauma, foreign body ingestion and iatrogenic perforation. The diagnosis and management of CEP remain challenging despite advances in surgery. Methods We present a series of 3 cases of CEPs, with multimodal approach for the management. Results In this series of 3 cases of CEPs with different presentations, tailored management strategies resulted with successful outcomes. Post-procedure/operative oral contrast study revealed no contrast leakage. Conclusion The diagnosis and management of CEP remain challenging despite advances in surgery. Contrasted CT scan and endoscopy are the mainstay of investigations. The treatment options of CEP range from conservative management to endoscopic intervention to surgical repair often with drainage procedures due to its frequent association with collections in the neck, pleural or mediastinal cavity. Prompt detection and early management with multimodal intervention ensure a better outcome in these patients.

Long-Term Survival Analysis of the North American Intergroup Study C9011 Comparing Fludarabine (F) and Chlorambucil (C) in Previously Untreated Patients with Chronic Lymphocytic Leukemia (CLL).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 536-536 ◽  
Author(s):  
Kanti R. Rai ◽  
Bercedis L. Peterson ◽  
Frederick R. Appelbaum ◽  
Martin S. Tallman ◽  
Andrew Belch ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Initial Treatment ◽  
Conflicts Of Interest ◽  
High Morbidity ◽  
Second Malignancies ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Prolymphocytic Leukemia

Abstract Abstract 536 Long-term outcomes following novel therapies for CLL have rarely been reported. Between 10/90 and 12/94, 509 eligible, untreated patients (pts) with symptomatic CLL were enrolled by 4 cooperative groups onto study C9011; 179 were randomized to F, 193 to C, and 137 to F+C. After slightly more than 5 years median follow up, with the time of last follow-up in June 1999, we reported in 2000 (NEJM 343:1750) that F provided significantly higher response rates and longer remission duration and progression-free survival (PFS) than C (p<0.001 for all 3 endpoints). The combination arm with F+C was stopped early because of high morbidity and mortality. There was no difference in overall survival (OS) among the 3 groups. Nearly 10 years have now elapsed since this report. Therefore, with the time of last follow-up in January 2009, we analyzed the long term outcomes of pts enrolled on the study. PFS was defined as the time between randomization and the occurrence of progressive disease or death due to any cause. Results: Of the 509 pts, 85% have now died; among pts on the F and C arms, 92% have progressed. We found that F treatment resulted in significantly longer PFS than did C (p < 0.001), with notable differences in PFS at 2, 3, and 4 years (Table). While the F and C arms had the same OS during the initial 5 years following randomization, our current analysis with longer follow-up shows that pts treated on the F arm had better survival than did those on the C arm during the ensuing years (Figure). The p-values for this difference are 0.04 (unadjusted for covariates) and 0.07 (covariate-adjusted). The emergence of improved survival following initial F treatment, appearing only after 5-6 years, is an unexpected and noteworthy finding. Reporting second malignancies was required on this study. There were 27 epithelial cancers reported (9 on F, 11 on C, 7 on F+C), involving colon, lung, breast, prostate, pancreas, liver, bladder and skin (6 squamous, 2 melanoma). Seven therapy-related myeloid neoplasms (t-MN) were reported; 6 were on F+C; 1 on F. Richter's transformation to non-Hodgkin lymphoma was reported in 34 pts; prolymphocytic leukemia occurred in 10; Hodgkin lymphoma in 6; myeloma in 2; hairy cell leukemia in 1. These cases were distributed with 18 on F, 18 on C, and 17 on F+C. Thus, the overall incidence of second malignancies reported was 17%. Conclusion: Initial treatment with F provides better long-term outcomes than initial treatment with C. Second malignancies are common, but the overall incidence is not increased on the F-containing treatment arms except for t-MN. Disclosures: No relevant conflicts of interest to declare.

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