R. Riccardi1,2, C. Nyberg1,2, R. S. Chamberlain1,2,3 1St. George’s University School Of Medicine,St. George’s, St. George’s, Grenada 2Saint Barnabas Medical Center,Livingston, NJ, USA 3New Jersey Medical School,Newark, NJ, USA
Introduction: Esophageal rupture is a life-threatening event with mortality rates as high as 60%. Self-expanding removable covered stents are increasingly being used for the treatment of acute benign esophageal injuries such as leaks or perforations. Data defining the use of esophageal stenting is currently limited or lacking, and the utilization of esophageal stents for perforation or leak is primarily anecdotal. This report provides a comprehensive systematic review of the indications, efficacy, and safety of endoluminal esophageal stents in the setting of esophageal perforations, anastomotic leaks, and fistulae.
Methods: A comprehensive search of PubMed,, Science Direct, Cochrane, and Google Scholar for reports examining the indications, efficacy, and safety of the use of self-expandable stents for the treatment of esophageal perforation and rupture was performed (1989-2014). Keywords included “esophageal stents,” “esophageal rupture,” and “self-expandable stents.” Thirty-five studies involving 907 patients were included in this review after meeting inclusion criteria of N > 5 and reported clinical outcomes.
Results: Thirty-five studies involving 907 patients reported an average intraoperative esophageal stent placement success rate of 89.8% with a range of 60.9-100%. Clinical success, defined as occlusion of the leak or perforation, was achieved in 79.5% of the patients treated for esophageal leaks, perforations, or fistulae. Length of stay ranged from 5-45 days. Stent migration was the most common complication occurring in 25.9% of patients. Mortality occurred in 69 out of 884 patients, comprising 7.8% of the study population.
Conclusion: Endoluminal esophageal stents are an effective and less invasive treatment for acute perforations. Successful stent implementation is achieved in a very high percentage of patients (60 – 100%); Specific patient selection criteria are ill defined at present and depend on the ability to provide mediastinal contamination control. The ideal stent type is poorly analyzed at present, and depends primarily on surgeon experience. Despite these caveats, esophageal stent should be considered as a primary treatment for the majority of patients in whom the stent is successfully deployed. Surgical exploration is warranted if clinical improvement is not achieved rapidly with non-operative management.