Published online Jul 28, 2018. doi: 10.3748/wjg.v24.i28.3192
Peer-review started: April 19, 2018
First decision: May 30, 2018
Revised: June 17, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: July 28, 2018
Processing time: 99 Days and 20.6 Hours
Using a fully covered self-expandable metallic stent (FSEMS) and Sengstaken-Blakemore tube (SBT) is a therapeutic method for correcting stent migration and regulating the complete migration of the stent into the stomach without the patient undergoing endoscopic rearrangement of the stent. It was effective for positioning a stent crossing the esophagogastric junction (EGJ).
The diagnoses were postoperative suture failure and perforation due to acute esophageal necrosis.
When Case 2 was hospitalized, treatment was started under the suspicion of cardiovascular disease.
In terms of the data before starting stent therapy, Case 1 had a white blood count of 7260 μL, CRP level of 11.8 mg/dL, and procalcitonin level of 1.5 ng/mL. Pseudomonas species were detected from the drain. Case 2 had a white blood cell count of 9850 μL, CRP level of 43.3 mg/dL, and procalcitonin level of 7.7 ng/mL. Klebsiella species were detected in the drain fluid sample.
Case 1 had contrast leakage from the suture site. Case 2 had a pneumothorax found on a computed tomography scan. An esophagogastroduodenoscopy revealed a blackened mucosal lesion, and perforations were found from the central to the lower part of the esophagus.
No pathological examination was performed.
A FSEMS was used for the stent therapy, and stent migration was controlled using a SBT.
No reports have described stent management using a SBT for esophageal perforation.
SBTs are generally used to control bleeding from esophageal varices. Acute esophageal necrosis is a rare syndrome characterized by esophageal mucosa with a diffuse blackened appearance, and tends to occur in the distal one-third of the esophagus.
This treatment is effective for positioning stents that cross the EGJ in distal esophageal perforation.