Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention.
Dr Wehrmann and colleagues from Germany treated 15 patients with paraesophageal abscesses, aged 39 to 76 years.
The researchers applied EUS-guided or endoscopic mediastinal puncture if the abscess was more than 2 cm and if sepsis was present.
Abscess cavities were entered with a 9.5 mm endoscope after balloon dilation to allow irrigation and drainage.
Debris was removed with a Dormia basket.
The research team treated concomitant pleural effusions with transthoracic drains.
|Etiology of perforation included Boerhaave's syndrome in 8 patients|
Patients received intravenous antibiotics and enteral/parenteral nutrition.
The researchers reported that 20 patients fulfilled the entry criteria, and were followed up for a median of 12 months.
Simple drainage was sufficient in 4 cases, and puncture was impossible in 1 case.
The team found that the etiology of perforation in 8 patients was Boerhaave's syndrome, anastomotic leak in 3, and iatrogenic perforation in 4 patients.
The researchers observed that debridement was successful in all cases and required a median of 5 daily sessions.
All patients became apyrexial, with a C-reactive protein levels of less than 5 mg/L within a median of 4 days .
The team noted that esophageal defects were closed with endoclips in 7 patients, with fibrin glue in 4, or metal stents in 1.
Esophageal defects spontaneously healed in 3 patients.
Of these patients, 1 died from a massive pulmonary embolism a day after successful debridement.
The researchers observed no other complications.
Dr Wehrmann's team concludes, “Nonoperative endoscopic transesophageal debridement of mediastinal abscesses appears safe and effective.”