Navigating Complex Esophageal Perforations: A Case-Specific Approach to Successful Outcomes

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Case Reports

Background:

• Esophageal perforation is a critical condition demanding immediate diagnosis and treatment.
• Self-expanding metal stents (SEMS) are a primary treatment, but persistent leaks may need additional endoscopic methods.
• A structured, multimodal strategy is vital for better outcomes and to prevent surgery.

Purpose of the Study:

• To present a case of iatrogenic esophageal perforation successfully managed with a stepwise endoscopic approach.
• To highlight the efficacy of combining SEMS, endoscopic suturing, and fixation techniques for complex perforations.

Main Methods:

• A 44-year-old male patient with iatrogenic esophageal perforation post-leiomyoma enucleation was treated.
• Initial management involved overlapping fully covered SEMS (FC-SEMS), followed by endoscopic suturing for reinforcement.
• A larger-diameter FC-SEMS with an endoscopic fixation system was used to manage persistent leakage.

Main Results:

• Initial FC-SEMS placement did not fully close the perforation.
• Endoscopic suturing reinforced the defect, but leakage persisted.
• The final placement of a larger FC-SEMS with fixation successfully achieved defect closure.
• The patient recovered without requiring surgical intervention.

Conclusions:

• A stepwise, individualized endoscopic strategy is crucial for managing complex esophageal perforations.
• Combining SEMS, endoscopic suturing, and fixation techniques improves closure success and reduces surgical necessity.
• This multimodal approach offers a viable alternative to surgery for esophageal perforations.