Patient-Reported Long-Term Outcome is Superior After Treatment with Self-Expanding Metallic Stents in Esophageal Perforations

Background and aims: Esophageal perforations are life threatening. Since the 1990s, placing of covered esophageal stents has become an alternative to surgery. Theoretically, this minimally invasive approach has several benefits; however, little data are available on long-term outcome in these patients. We aimed to evaluate how patient-reported outcome differed between full surgery and placement of self-expanding metallic stents when treating primary benign esophageal perforations. Material and methods: Of 48 patients treated at our hospital in 2000–2015, 23 were alive and asked to answer three questionnaires. We used a short clinical questionnaire, the QLQ-OG25 from the European Organization for Research and Treatment of Cancer and a simplified quality-of-life instrument, the Check Your Health. Non-parametric statistics were used to evaluate differences between the two groups. Results: In all, 20 (87%) individuals (13 men, 64 years of age) responded. At survey, surgical patients had lost 13 kg of initial weight, compared to no weight loss in the self-expanding metallic stents group (p = 0.01). This involuntary weight loss worried patients according to the QLQ-OG25; otherwise patient-experience measures did not differ between groups. For quality of life, surgical patients scored significantly lower physical health, emotional well-being, social functioning, and overall quality of life after treatment, but after stenting no differences were seen. Conclusions: In contrast to stenting, surgical treatment was associated with involuntary, and worrisome, weight loss as well as reduced quality of life. We therefore believe that self-expanding metallic stents should be used when possible in treating benign esophageal perforations.

PS01.082: ESOPHAGEAL PERFORATIONS: WHAT TO DO?

Background Esophagus perforations are one of the most severe lesions of the digestive tract. Until now the treatment continues to be controversial, with mortality greater than 30% of cases, mainly with a thoracic location. Severity is determinate by the progression of infection due to anatomical characteristics of the mediastinum. The location, size of the perforation and the evolution time determine the treatment to follow. In order to assess the results obtained and the different management options we present a series of 9 patients, with benign esophageal perforations, treated in our center during the last 5 years. Methods We designed an observational study in which we identify retrospectively the results of our series during the last five years (From 2013 to 2018). We analysed the following variables: Characteristics of patients, medical and surgical management, morbidity and mortality Results In all series, 5 of 9 patients received surgical treatment (55,5%), In the remaining three cases, simple suture and placement of drainages was performed. Conservative treatment was the first management attempt in the last four cases (44,5%), all of them due to impaction of food bolus or foreign body. Of all series evolved favourably with a non-negligible morbidity and continued ambulatory follow up. There was no mortality. Conclusion It is difficult to establish a protocol of action in patients with esophageal perforation. We have obtained good results by individualizing each case and adjusting the type of treatment to the needs of each patient, from a conservative attitude to radical surgery. Disclosure All authors have declared no conflicts of interest.