Wednesday, December 03, 2014

Management of iatrogenic esophageal perforation with endoscopic stenting

Management of iatrogenic esophageal perforation with endoscopic stenting
Presenting Author: NAWAF ZAKARY
Additional Authors: ALGUILI ELSHEIKH, NOOF HAMID, HIND HAMID, MOHAMMED ALGHAMDI, WALID FARAH
Corresponding Author: NAWAF ZAKARY
Affiliations: King Fahad Military Medical Complex

Objective: Esophageal perforation is a challenging disease process with high morbidity and mortality. Despite the availability of diagnostic radiological tools, there is still a chance of delaying in diagnosis, because of non specific symptoms. In clinical practice 60% of cases are iatrogenic due to endoscopic procedures. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours.

Case Presentation: We like to present a 67 year old female patient of achalasia. She presented with weight loss and progressive dysphagia. Barium swallow and gastroscopy confirmed the diagnosis. She underwent successful first session of endoscopic pneumatic dilation but after the second session, she developed shortness of breath and abdominal pain. Gastrographin studies and computer tomography scan of the chest and abdomen confirmed the diagnosis of esophageal perforation. She was managed conservatively with endoscopic stenting, to which she recovered fully.

Conclusion: Esophageal perforation is a highly morbid condition with high mortality. More accurate diagnosis and less-invasive treatment are reducing morbidity and mortality to more acceptable levels. While surgery remains the gold standard treatment, less invasive and endoscopic methods are being explored, and their role is evolving. For optimum outcome for management of esophageal perforations, a multidisciplinary approach is needed.

Key Word(s): 1. achalasia; 2. esophageal perforation; 3. esophageal stenting

© 2014 The Authors. Journal of Gastroenterology and Hepatology

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