Predictors for failure of stent treatment for benign esophageal perforations - a single center 10-year experience

Table 1 Summary of patients who received other primary treatment than stenting with intention to heal

Cause of perforation	Localization	Treatment	Reason other treatment
Iatrogenic	Cervical	Drainage and antibiotics	Stent not well tolerated in cervical part
Boerhaave	Distal	Drainage and antibiotics	Treated at another hospital
Foreign body	Cervical	Suture	Stent not well tolerated in cervical part
Boerhaave	Distal	Suture	Large, longstanding lesion
Swallowed knives	Cervical	Suture	Required surgical removal of knife
Unknown	Cervical	Suture	Stent not well tolerated in cervical part
Boerhaave	Distal	Stent	Palliation
Boerhaave	Distal	Esophagectomy	Large, circumferential lesion

Table 2 Patient and lesion characteristics according to stent treatment outcome

	Stent and recovery	Stent and failure	P value
	n = 33 (83%)	n = 7 (17%)
Age, median (range)	62 (10-82)	68 (35-76)	0.193
Sex, M:F	23:10	5:02	1.000
ASA score1	2 (1-2)	2 (2-3)	0.338
Smoker, n = 35	8 (29)	4 (57)	0.200
Alcohol misuse, n = 31	8 (32)	2 (33)	1.000
Cardiovascular disease	12 (36)	5 (71)	0.113
Diabetes	3 (9)	1 (14)	0.552
Pulmonary disease	5 (15)	1 (14)	1.000
Localization			0.224
Distal	17 (57)	6 (86)
Cause of perforation			0.570
Trauma	1 (3)	0
Boerhaave	20 (61)	3 (43)
Iatrogenic	12 (36)	4 (57)
Foreign body	0	0
Primary pleural rupture, n = 36	15 (50)	3 (50)	1.000
Time to stent2 (d), n = 38	1 (1-1)	3 (1-10)	0.020
CRP (mg/L)	63 (21-251)	122 (48-280)	0.572
Albumin (g/L), n = 29	25 (21-33) n = 22	28 (19-35) n = 7	0.878
Creatinine (μmol/L), n = 38	80 (69-137)	80 (46-103)	0.522
BMI (kg/m2), n = 32	24.8 (22.3-27.9)	23.9 (21.7-26.3)	0.698

¹Before the perforation;

²Time between symptom onset or injury and placement of stent. Values are n (%) or median (IQR) unless otherwise indicated. CRP: C-reactive protein; ASA: American Society of Anesthesiologists; M: Male; F: Female.

Table 3 Overall outcome and in-hospital treatment strategies

	Stent and recovery	Stent and failure	P value
	n = 33 (83%)	n = 7 (17%)
In hospital mortality	0	3 (43)	0.004
Time to recovery	29 (19-55)	-
Time to new strategy	-	12 (7-15)
Days of hospitalization	29 (15-48)	54 (18-91)	0.227
Days in ICU	1 (0-7)	14 (11-38)	0.001
Dialysis	0	2 (29)	0.027
Ventilator support	9 (27)	7 (100)	0.001
Sealed leakage after first stent			0.026
Yes n = 22	17 (71)	1 (17)
No n = 8	7 (29)	5 (83)
Endoscopic reintervention1			0.234
0	19 (57)	2 (29)
1	8 (24)	3 (43)
2	4 (12)	2 (29)
3	2 (6)	0
Number of drainage procedures2	3 (2-5)	4 (2-8)	0.552

¹Including change, adjustment or addition of stent;

²Including percutaneous drainage, laparotomy, thoracoscopy and thoracotomy. Values are n (%) or median (IQR). ICU: Insensive Care Unit.

Table 4 Uni-variate logistic regression analysis

Variables	OR	95%CI		Pvalue
		Lower	Upper
Age	1.035	0.972	1.102	0.279
Sex	1.087	0.180	6.576	0.928
ASA score	2.495	0.709	8.778	0.154
Smoker, n = 35	3.333	0.605	18.371	0.167
Alcohol misuse, n = 31	1.062	0.160	7.061	0.950
Cardiovascular disease	4.375	0.733	26.116	0.105
Diabetes	1.667	0.147	18.874	0.680
Pulmonary disease	0.933	0.092	9.507	0.954
Localization	4.421	0.477	40.980	0.191
Cause of perforation	2.368	0.479	11.707	0.290
Primary contaminated pleura	1.000	0.173	5.772	1.000
Time to stent, days n = 38	1.368	1.016	1.843	0.039
CRP, mg/L n = 38	1.000	0.995	1.006	0.902
Albumin, g/L n = 29	1.015	0.902	1.142	0.805
Creatinine, μmol/L n = 38	0.992	0.973	1.011	0.409
BMI, kg/m2, n = 32	0.936	0.746	1.173	0.564

CRP: C-reactive protein; BMI: Body mass index.

Table 5 Multi-variate analysis

Variables	OR	95%CI		Pvalue
		Lower	Upper
ASA score	3.355	0.392	28.749	0.269
Cardiovascular disease	4.247	0.188	95.721	0.363
Smoker	0.672	0.672	9.515	0.768
Localization	350.103	0.192	637196.344	0.126
Time to stent, d, n = 38	1.802	1.802	3.264	0.052