Navigating Complex Esophageal Perforations: A Case-Specific Approach to Successful Outcomes

Authors

• Harsimran Kalsi, HCA Florida North Florida Hospital, Gainesville, FLFollow
• Anushree Rai, Chhattisgarh Institute of Medical Sciences College, Chhattisgarh, IndiaFollow
• Kobina Essilfie-Quaye, HCA Florida North Florida Hospital, Gainesville, FLFollow
• Neeka Akhavan, University of Florida, Gainesville, FLFollow
• Yaseen Perbtani, HCA Florida North Florida Hospital, Gainesville, FLFollow
• Tony S. Brar, HCA Florida North Florida Hospital, Gainesville, FLFollow

Keywords

endoscopic management; endoscopic suturing; esophageal perforation; self-expanding metal stent; stent fixation; stent migration

Disciplines

Digestive System Diseases | Gastroenterology | Internal Medicine

Abstract

Esophageal perforation is a life-threatening condition requiring prompt diagnosis and effective management. While self-expanding metal stents (SEMS) are a first-line treatment, persistent leaks often necessitate adjunctive endoscopic interventions. A structured, multimodal approach is critical for optimizing outcomes and avoiding surgical intervention. A 44-year-old man developed an iatrogenic esophageal perforation following surgical leiomyoma enucleation. Initial treatment with overlapping fully covered self-expanding metal stents (FC-SEMS) failed to achieve closure, necessitating endoscopic suturing for defect reinforcement. Despite suturing, persistent leakage required placement of a larger-diameter FC-SEMS, secured with an endoscopic fixation system to prevent migration. Serial imaging confirmed successful defect closure, allowing the patient to recover without the need for surgical intervention. This case underscores the importance of a stepwise, individualized endoscopic approach in managing complex esophageal perforations. A combination of SEMS, endoscopic suturing, and fixation techniques can enhance closure success and prevent complications, reducing the need for surgery.

Recommended Citation

Kalsi, Harsimran; Rai, Anushree; Essilfie-Quaye, Kobina; Akhavan, Neeka; Perbtani, Yaseen; and Brar, Tony S. (2026) "Navigating Complex Esophageal Perforations: A Case-Specific Approach to Successful Outcomes," HCA Healthcare Journal of Medicine: Vol. 7: Iss. 3, Article 7.
DOI: 10.36518/2689-0216.2216
Available at: https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol7/iss3/7