Nonsurgical treatment of esophageal perforations after endoscopic palliation in advanced esophageal cancer

Background and Study Aims: Iatrogenic esophageal perforation during palliative 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 nonsurgical and surgical treatment regimens are used, The present study describes a nonsurgical regimen, Patients ann Methods: Nine cases of perforation occurred in 142 consecutive patients referred for endoscopic palliation of dysphagia, corresponding to a perforation rate of 6%. Laser therapy was the main treatment used (argon plasma coagulation or Nd:YAG photocoagulation), Results: Nonsurgical treatment was successful in six patients (75 %), Two patients died (22 %) as a direct result of esophageal perforation following endoscopic palliation procedures, Conclusion: These findings show an acceptable mortality rate using a nonsurgical treatment regimen involving broad-spectrum antibiotics, nasogastric suction, and parenteral nutrition, with pleural drainage and endoprosthesis placement in addition when indicated.