Spontaneous esophageal perforation (Boerhaave syndrome) most often results from an abrupt rise in esophageal pressure. When the perforation is contained and the patient remains hemodynamically stable with an early presentation, a focused non-surgical strategy can be appropriate.
Spontaneous (Boerhaave) esophageal perforation with hemodynamic stability, presentation within 24 hours, contained perforation, minimal peri-esophageal contamination, and absence of signs or symptoms of sepsis.
Management centres on endoscopic intervention directed at the perforation, with the specific technique guided by the extent of the defect.
Goal: sealing of the esophageal perforationSpontaneous esophageal perforation (Boerhaave syndrome) is most often due to an abrupt increase in the esophageal pressure following a vomiting effort in the absence of relaxation of the superior esophageal sphincter.
Non-operative management (NOM) of EP can be considered in stable patients with early presentation, contained esophageal disruption, and minimal contamination of surrounding spaces if highly specialized surveillance is available (Grade 1C).
Endoscopic clip placement (through the scope clips, over the scope clips) is currently the standard method for closing small (< 2 cm) luminal perforations.
Endoscopic stents (partially or fully covered self-expandable metal stents, self-expandable plastic stents) can be used to cover larger defects or complete unsatisfactory clip closure.
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