Should we use E-SEMS or EVT for traumatic oesophageal perforations?

Although endoscopic self-expandable metal stents (E-SEMS) and endoscopic vacuum therapy (EVT) yielded similar clinical outcomes for the treatment of traumatic oesophageal perforations in the FORTAL trial, participants who underwent E-SEMS had a shorter hospital stay than those who underwent the EVT procedure. Moreover, the costs of E-SEMS were significantly lower than for EVT.

“Oesophageal perforation may lead to mediastinitis, empyema, sepsis, and eventually, organ failure,” outlined Dr Alessandrino Terceiro de Oliveira (Federal University of Ceará, Brazil) [1]. “Surgical interventions to tackle this issue are associated with a mortality rate of up to 20%.” The single-centre, randomised, double-blind, controlled FORTAL trial compared the efficacy of E-SEMS versus EVT in participants with a traumatic oesophageal perforation (n=30).

No significant differences were observed in clinical outcomes between the two arms. In the E-SEMS arm, 93.7% of the participants were discharged and 6.3% had deceased. The corresponding rates for the EVT arm were 71.4% (P=0.16) and 28.6% (P=0.16). Dr Terceiro de Oliveira added that the treatment duration was significantly longer in the E-SEMS arm than in the EVT arm (mean 45.8 days vs 24.4 days; P<0.05). In contrast, the length of hospital stay was significantly shorter among patients in the E-SEMS arm (number of days vs number of days; P=0.021). Finally, the mean cost of an E-SEMS procedure was substantially lower than the mean cost of an EVT procedure (€19,266 vs €38,453; P=0.013).

The current randomised-controlled trial provided insights into the differences between the 2 investigated surgical approaches in terms of treatment duration, length of hospital stay, and costs. Larger studies are needed to observe whether the procedures differ with regard to clinical outcomes.

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   1. Terceiro de Oliveira A, et al. Endoscopic self-expandable metal stent (E-SEMS) versus endoscopy vacuum therapy (EVT) for traumatic esophageal perforations: the FORTAL randomized double-blind controlled comparative effectiveness trial. LB12, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

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Posted on 7 December 2023