NONSURGICAL TREATMENT OF ESOPHAGEAL PERFORATIONS AFTER ENDOSCOPIC PALLIATION IN ADVANCED ESOPHAGEAL CANCER

Background and Study Aims: Iatrogenic esophageal perforation during pa lliative endoscopic treatment in patients with incurable esophageal or cardiac cancer is a severe complication, associated with a high rate of mortality, The treatment remains controversial, since both nonsurgi cal and surgical treatment regimens are used, The present study descri bes a nonsurgical regimen, Patients ann Methods: Nine cases of perfora tion occurred in 142 consecutive patients referred for endoscopic pall iation of dysphagia, corresponding to a perforation rate of 6%. Laser therapy was the main treatment used (argon plasma coagulation or Nd:YA G photocoagulation), Results: Nonsurgical treatment was successful in six patients (75 %), Two patients died (22 %) as a direct result of es ophageal perforation following endoscopic palliation procedures, Concl usion: These findings show an acceptable mortality rate using a nonsur gical treatment regimen involving broad-spectrum antibiotics, nasogast ric suction, and parenteral nutrition, with pleural drainage and endop rosthesis placement in addition when indicated.