Subscribe to RSS
DOI: 10.1055/s-0030-1256287
© Georg Thieme Verlag KG Stuttgart · New York
Use of endoscopic nasobiliary drainage tube for treating mediastinitis caused by insertion of an esophageal self-expanding metal stent
K. Soga
Nishijin Hospital
Department of Internal Medicine
1035 Mizomae-cho
Kamigyo-ku
Kyoto
602-8319
Japan
Fax: +81-75-461-5514
Email: sogatti@koto.kpu-m.ac.jp
Publication History
Publication Date:
25 May 2011 (online)
Self-expanding metal stents (SEMS) are relatively easy to deploy, with a high technical success rate, and provide rapid relief of dysphagia [1], which is the major factor affecting quality of life in patients not suitable for resection. Since Domschke et al. first reported the use of SEMS in 1990 [2], the technique has been widely used for malignant esophageal stenosis [3], although there have been many reports of complications associated with the combination of SEMS and chemoradiation therapy (CRT) [4] [5].
A 56-year-old man was diagnosed as having carcinoma of the lower esophagus in July 2008. After CRT, he was admitted to our hospital for second-line chemotherapy in October 2008. The patient had developed uncontrollable salivation in the month prior to admission. A SEMS was placed successfully, but he developed fever and low blood pressure on November 28, 2008. Computed tomography (CT) examination revealed a fistula between the esophagus at the oral end of the SEMS and the mediastinum, and mediastinitis was suspected. Despite the administration of antibiotics, and steroid pulse and γ-globulin combination therapy, an abscess with liquefaction was confirmed in the mediastinum 7 days later ([Fig. 1]).
An endoscopic nasobiliary drainage (ENBD) tube was placed in the mediastinal abscess along a guide wire to allow drainage ([Fig. 2]).
A CT scan demonstrated improvement in the abscess 12 days after insertion of the ENBD tube ([Fig. 3]).
The risks and benefits of SEMS insertion must be weighed in light of the existing illness and the patient’s quality of life. We report the case of a patient with esophageal carcinoma treated with CRT who developed mediastinitis after SEMS insertion. Mediastinitis was treated by esophago-mediastinal drainage of the mediastinal abscess via the insertion of an ENBD tube. This technique has not been previously reported, but appears to represent a useful method for management of mediastinitis after SEMS insertion.
Endoscopy_UCTN_Code_TTT_1AO_2AI
Competing interests: None
#References
- 1 Dua K S. Stents for palliating malignant dysphagia and fistula: is the paradigm shifting?. Gastrointest Endosc. 2007; 65 77-81
- 2 Domschke W, Foerster E C, Matek W et al. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy. 1990; 22 134-136
- 3 Raijman I, Siddique I, Ajani J et al. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc. 1998; 48 172-179
- 4 Kinsman K J, DeGregorio B T, Katon R M et al. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc. 1996; 43 196-203
- 5 Muto M, Ohtsu A, Miyata Y et al. Self-expandable metallic stents for patients with recurrent esophageal carcinoma after failure of primary chemoradiotherapy. Jpn J Clin Oncol. 2001; 31 270-274
K. Soga
Nishijin Hospital
Department of Internal Medicine
1035 Mizomae-cho
Kamigyo-ku
Kyoto
602-8319
Japan
Fax: +81-75-461-5514
Email: sogatti@koto.kpu-m.ac.jp
References
- 1 Dua K S. Stents for palliating malignant dysphagia and fistula: is the paradigm shifting?. Gastrointest Endosc. 2007; 65 77-81
- 2 Domschke W, Foerster E C, Matek W et al. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy. 1990; 22 134-136
- 3 Raijman I, Siddique I, Ajani J et al. Palliation of malignant dysphagia and fistulae with coated expandable metal stents: experience with 101 patients. Gastrointest Endosc. 1998; 48 172-179
- 4 Kinsman K J, DeGregorio B T, Katon R M et al. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc. 1996; 43 196-203
- 5 Muto M, Ohtsu A, Miyata Y et al. Self-expandable metallic stents for patients with recurrent esophageal carcinoma after failure of primary chemoradiotherapy. Jpn J Clin Oncol. 2001; 31 270-274
K. Soga
Nishijin Hospital
Department of Internal Medicine
1035 Mizomae-cho
Kamigyo-ku
Kyoto
602-8319
Japan
Fax: +81-75-461-5514
Email: sogatti@koto.kpu-m.ac.jp