Muaataz Azawi, MD1, Soohwan Chun, MD2, Raghav Bansal, MD3
1Elmhurst Hospital Center, Astoria, NY; 2Elmhurst Hospital Center, Elmhurst, NY; 3Icahn School of Medicine at Mount Sinai - Elmhurst, Elmhurst, NY
Introduction: Boerhaave's syndrome a rare yet frequently fatal diagnosis, is characterized by transmural rupture of the esophagus. The classic presentation of Boerhaave syndrome is characterized by Mackler's triad, consisting of chest pain, vomiting, and subcutaneous emphysema. Boerhaave syndrome can occur in patients with a normal underlying esophagus or pathological esophagus, such as eosinophilic esophagitis, Barrett's and malignancy. Rupture of the esophagus results in contamination of the mediastinal cavity with gastric contents, and subsequently bacterial infection and mediastinal necrosis. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies.
Case Description/Methods: 57 year-old male presented with trauma in setting of alcohol intoxication. In the ED patient was found to have a left hemopneumothorax found in CT scan. The patient was admitted for lactatemia and chest tube management. Afterwards patient developed sepsis due to empyema which prompted him to undergo for VATs procedure. Patient remained septic and CT with contrast revealed an esophageal leak and Boerhaave’s syndrome was suspected. GI was consulted and patient underwent EGD. A 8 mm perforation was found in the left latero-posterior portion of the esophagus consistent with Boerhaave syndrome. To repair the defect, the tissue edges were approximated using suction and one 11 mm OTSC was successfully placed (Bear claw). Thereafter patient underwent g-tube and j-tube placement. Next, the patient was discharged home and was seen in the clinic, where the g-tube and j-tube was removed.
Discussion: The current management of BS includes conservative, endoscopic, and surgical treatments. The survival rates for each treatment are 75%, 100%, and 81%, respectively. The estimated mortality rate of patients with BS is 20%–40%. Endoscopy can be utilized to confirm the diagnosis of BS, particularly in equivocal cases. Endoscopic treatment with stenting can be effective and less invasive. In a systematic review that, endoscopic stenting had a success rate of 81% but endoscopic intervention was required in 17% and surgical reintervention in 10% patients. More recently, the use of OTSC has been reported in treatment of boerhaave’s alone or in combination with local therapies or esophageal stent. These endoscopic interventions are typically performed within several days of the perforation. Here we report successful closure of boerhaave with use of OTSC alone after 14 days from perforation.
Citation: Muaataz Azawi, MD; Soohwan Chun, MD; Raghav Bansal, MD. P1200 - BOERHAAVE'S SYNDROME WAS TREATED WITH OVER-THE-SCOPE CLIP OTSC CLOSURE (BEAR CLAW CLOSURE): A RARE CASE REPORT. Program No. P1200. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.