Eitan Podgaetz, MD, MPH, Rafael S Andrade, Illitch Diaz, Rafael Garza-Castillon. University of Minnesota
Abstract Purpose: Esophageal perforation is a condition with high mortality rate. Traditional operative repair represents a major procedure with high levels of morbidity and prolonged convalescence for patients. We propose the use of natural orifice transluminal endoscopic surgery (NOTES) for contained perforations allowing drainage, lavage and focal decompression via cervicomediastinal tubes (i.e-pharyngostomy)
Abstract Methods: We report indication and short term outcomes. Our approach is endoscopy and on-table esophagram with balloon occlusion to define the perforation and mediastinal cavity. If we drain the infected cavity and debride with power antibiotic irrigation. A pharyngostomy tube is used for decompression. We perform weekly debridement, retracting the tube back as the cavity collapses and heals.
Abstract Results: We performed mediastinal drainage in 6 patients with large complex esophageal perforations. Two were postoperative leaks (one after esophagectomy and one after a redo Heller myotomy), one perforation after esophageal dilation in a patient with laryngectomy, one from Boerhaave’s in a patient with Achalasia, one iatrogenic with TEE in a patient with severe mitral regurgitation and one after laparoscopic partial fundoplication at a community hospital.
Our patients required median 4 procedures (3-6) at 4-10 day intervals before removal of the drain and initiation of oral intake (Fig 1). Complications were an anastomotic stricture requiring repeated dilations in the patient with a gastric pull-up. The other patients healed completely without stricture and were able to tolerate a regular diet within a month of completion of therapy.
Abstract Conclusions: In selected patients NOTES approaches can result in excellent outcomes for contained esophageal perforations with complex mediastinal cavities avoiding the morbidity of traditional surgical approaches.
Keywords List: Esophagus,Esophageal injury/perforation, stents
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77648
Program Number: S075
Presentation Session: Flexible / Therapeutic Endoscopy and NOTES
Presentation Type: Podium