Introduction

Oesophageal injuries and perforations are transmural ruptures of the oesophagus that subsequently lead to leakage of intraluminal contents into the surrounding mediastinum. This causes local inflammation, a systemic inflammatory response, and eventually the development of sepsis, resulting in significant morbidity and mortality.

Aims & Methods

This study aimed to compare oesophageal self-expandable metal stent (E-SEMS) with endoscopic vacuum therapy (EVT) in oesophageal perforations (EP) treatment. We randomly evaluated 30 patients with traumatic EP. The E-SEMS and EVT groups were assessed for treatment duration, duration of hospitalisation, LOS (length of stay), clinical outcomes, and treatment success.

Results

In both groups, the most common cause of injury was a foreign body 63.3% (19/30), followed by gunshot wounds 30.0% (9/30) and stab wounds 6.7% (2/30). The treatment duration for E-SEMS (45.8±12.9) was significantly longer than EVT (24.42±13.21), p<0.005. Evaluating the clinical results, E-SEMS demonstrated a 93.75% (15/16) discharge rate compared to EVT which showed 71.4% (10/14). Deaths occurred in the E-SEMS and EVT groups at rates of 6.3% (01/16) and 28.6% (04/14) respectively, p=0.1571. Treatment success showed no significant difference between E-SEMS 93.7% (15/16) and EVT 78.6% (11/14), p=0.3155. The costs were calculated at €19,266.08±10,925.00 for E-SEMS and €38,453.17±23,840.40 for EVT, respectively.

Conclusion

E-SEMS had a longer treatment duration compared to EVT. Both therapies showed no significant difference in clinical outcome and treatment success. The overall cost was lower for E-SEMS compared to EVT.

Disclosure

Alessandrino Terceiro de Oliveira, Amanda Cyntia Lima Fonseca Rodrigues, José Wilson da Cunha Parente Júnior, José Ruver Lima Herculano Junior, Jeany Borges e Silva Ribeiro, Orleancio Gomes Ripardo de Azevedo, and Paulo Roberto Cavalcante de Vasconcelos have no conflicts of interest.

Introduction

The PROTDILAT study (Loras et al. Lancet Gastroenterol Hepatol. 2022) at 1-year follow-up showed greater efficacy of EBD vs SEMS for the treatment of short strictures in CD. However, long term efficacy of endoscopic treatmetn is still debated, especially for EDB.

Aims & Methods

Aims: To assess the long-term evolution of patients included in PROTDILAT study. 1). Percentage of patients free of surgery; 2) Factors related to surgery; 3) Need for endoscopic retreatments; 4) Effectiveness related to the type of initial endoscopic treatment (EBD vs SEMS); 5) Complications related to endoscopic or surgical treatment.
Methods: Retrospective study based on PROTDILAT trial database (patients with CD, obstructive symptoms, with stenosis <10cm). Data on medical, endoscopic and surgical treatment and smoking habits were collected. The effectiveness of endoscopic treatment is defined by the percentage of patients free of surgery and endoscopic retreatment at the end of follow-up.

Results

Information available on 80/80 patients (39 SEMS, 41 EBD), 39 women, age (median): 45y (IQR: 38-55); median stricture length 3.4cm (IQR: 2-5.5), 42.5% being anastomotic. Thirty-one percent (25/80) of patients required surgical resection [(median time to surgery 30.61 months (6.35-55.24)). Factors associated to surgery: non-intensification of therapy (HR 0.26 (0.10-0.68)), treatment with EBD exclusively (HR 0.22 (0.08-0.58)) (with respect to treatment with EBD + SEMS) and number of stents (HR 2.31 (1.10-4.84)). Of the 55 patients free of surgery, during the entire follow-up (median 84 months (74.7-84.0)), a median of 2 endoscopic procedures (1-3) were performed: EBD in 45 cases (80.0%) and SEMS in 26 cases (46%). Thirty-eight-point seventy-five percent (31/80 patients) did not require neither surgery nor endoscopic retreatment during the follow-up. The long-term effectiveness of endoscopic treatment was 45% for SEMS and 57.6% for EBD (p=0.374). The complications related to endoscopic or surgical treatment were 8.75% (7/80) versus 36% (9/25) respectively (p=0.002). As for the severity of complications (AGREE/CLAVIEN-DINDO ≥ III), it was observed that surgical treatment presented more severe complications than endoscopic treatment (Endoscopic vs surgical treatment: 38% (3/8) vs 84% (10/12), p=0.011).

Conclusion

Endoscopic treatment (predominantly EBD) avoids surgery in most cases, requiring a low number of endoscopic treatments in the long-term. Patients at higher risk for surgery are those with a greater number of endoscopic treatments that include SEMS and EBD. On the contrary, protective factors are non-intensificationof therapy and having been treated exclusively with EBD. Although there are no significant differences in the long effectiveness between SEMS and EBD, a trend for a better outcome is observed for EBD. To highlight a significant higher rate of complications observed in surgicaltreatment compared to endoscopic treatment.

References

Loras et al. Lancet Gastroenterol Hepatol. 2022

Disclosure

No conflict of Interest