Endotherapy for a 5-cm mid-esophageal perforation with tandem stenting above the lower esophageal sphincter (with videos)

Background: Esophageal perforation, whether spontaneous or more commonly as a result of instrumentation, is a life-threatening condition and carries high mortality despite recent advances. Outcome is dependent on etiology, location of injury, and interval between perforation and initiation of therapy. Successful management of esophageal perforation entails combination of: (1) control of the leakage site either surgically or endoscopically to prevent further contamination, (2) drainage of contamination, and (3) appropriate antibiotics along with nutritional support. Methods: We report one case with a 5-cm-long iatrogenic mid-esophageal perforation. The perforation was successfully managed with esophageal tandem stenting above the lower esophageal sphincter (LES). Results: The radial expansile force of the inner stent and its anchorage by LES holds the outer stent in place and prevents the tandem stents migrating distally. Conclusions: Successful management of esophageal perforation depends on early diagnosis, control of site of leak, drainage of accompanying collections, and antibiotic and nutritional support.