Iatrogenic
esophageal perforation during endoscopy in the setting of
malignancy is an uncommon but often devastating complication and presents a formidable challenge to the surgeon. We sought to determine the efficacy of a self-expanding
plastic stent for
esophageal perforation before
neoadjuvant chemoradiation in a single patient. A 74-year-old woman with a T4N0
adenocarcinoma at the gastroesophageal junction was perforated during upper endoscopy. We elected to manage the perforation with a
silicone-covered, self-expanding Polyflex
stent. Subsequent studies revealed good positioning of the
stent with exclusion of the perforation from the esophageal lumen. The patient subsequently underwent
neoadjuvant chemoradiation therapy with
cisplatin, 5-flourouracil, and external beam radiation (2640 Gy) followed by minimally invasive, hand-assisted transhiatal esophagogastrectomy. We describe the first case of endoscopic stenting for locally advanced, perforated
esophageal cancer for the purposes of administering
neoadjuvant chemoradiation as a bridge to definitive surgery. This patient was able to resume oral nutrition after stenting and during
neoadjuvant therapy, experiencing no major complications from chemoradiation. Chemoradiation does not necessarily preclude the use of endoscopically placed covered
plastic esophageal
stents as a bridge to resection, even in the face of iatrogenic perforation.