Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series.

Abstract

BACKGROUND:

Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention.

METHODS:

Patients with paraesophageal abscesses were treated with EUS-guided or endoscopic mediastinal puncture if the abscess was >2 cm and sepsis was present. Abscess cavities were entered with a 9.5-mm endoscope after balloon dilation to allow irrigation and drainage. Debris was removed with a Dormia basket. Concomitant pleural effusions were treated with transthoracic drains. Patients received intravenous antibiotics and enteral/parenteral nutrition.

RESULTS:

Twenty patients fulfilled the entry criteria. Simple drainage was sufficient in 4 cases, and puncture was impossible in one case. Of the 15 treated patients (age 39-76 years, 5 women) the etiology of perforation was Boerhaave's syndrome (n = 8), anastomotic leak (n = 3), and iatrogenic perforation (n = 4). Debridement was successful in all cases and required a median of 5 daily sessions (range 3-10). All patients became apyrexial, with a C-reactive protein < 5 mg/L within a median of 4 days (range 2-8 days). Esophageal defects were closed with endoclips (n = 7), fibrin glue (n = 4), metal stents (n = 1), or spontaneously healed (n = 3). One patient died from a massive pulmonary embolism one day after successful debridement (mortality 7%). No other complications were seen. Median follow-up was 12 months (range 3-40 months).

CONCLUSIONS:

Nonoperative endoscopic transesophageal debridement of mediastinal abscesses appears safe and effective.

• Authors: Till Wehrmann, Nikos Stergiou, Bernd Vogel, Andrea Riphaus, Ferdinand Köckerling, Markus B Frenz
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 62 Issue 3 Pg. 344-9 (Sep 2005) ISSN: 0016-5107 [Print] United States
• PMID: 16111949 (Publication Type: Comparative Study, Journal Article)

Topics

• Abscess (diagnostic imaging, surgery)
• Adult
• Aged
• Cohort Studies
• Debridement (methods)
• Endosonography (methods)
• Esophageal Perforation (complications, diagnostic imaging)
• Esophagoscopy (methods)
• Esophagus
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Male
• Mediastinal Diseases (diagnostic imaging, etiology, surgery)
• Middle Aged
• Minimally Invasive Surgical Procedures (methods)
• Prospective Studies
• Risk Assessment
• Treatment Outcome