Aloreidi Khalil, Patel Bhavesh, Ridgway Tim, Yeager Terry, Atiq Muslim
Department of Internal Medicine, University of South Dakota - Sanford School of Medicine, Sioux Falls, South Dakota, United States.
Department of Gastroenterology, University of South Dakota - Sanford School of Medicine, Sioux Falls, South Dakota, United States.
Endosc Int Open. 2018 Jan;6(1):E92-E97. doi: 10.1055/s-0043-124075. Epub 2018 Jan 16.
Boerhaave's syndrome (BS) is a life-threatening condition with morbidity and mortality rates as high as 50 % in some reports. Until recently, surgical intervention has been the mainstay of management plans. With advances in therapeutic endoscopy, however, there has been increasing interest in non-surgical options including endoscopic esophageal stenting.
We reviewed the medical records of all patients diagnosed with BS and managed with endoscopic interventions between November 2011 and November 2016. The following variables were collected: patient demographics, clinical presentations, locations of esophageal perforation, primary interventions, complications, and outcomes.
Six patients were found to be diagnosed with BS during the study period. The median age at presentation was 55. There were 4 males and 2 females. The most common site of perforation was in the distal esophagus. The most common presenting symptom was chest pain (67 %) following an episode of vomiting or retching. Four patients (66.7 %) developed septic shock. Endoscopic treatment with a fully covered esophageal stent was the primary intervention in all patients (100 %). Interventional radiology was consulted in all cases for fluid drainage and chest tube placements. Clinical resolution of the BS was achieved in all patients (100 %) without any subsequent surgical interventions. There were no deaths within the study group, and the average follow-up duration was 2 years.
Endoscopic treatment seems to be an effective management strategy in patients with BS. We also noted satisfactory results in patients presenting with sepsis, presumably due to urgent, interventional radiology-guided fluid drainage.
博雷尔哈夫综合征（BS）是一种危及生命的疾病，在一些报告中，其发病率和死亡率高达50%。直到最近，手术干预一直是治疗方案的主要手段。然而，随着治疗性内镜技术的进步，包括内镜下食管支架置入术在内的非手术治疗方案越来越受到关注。
我们回顾了2011年11月至2016年11月期间所有诊断为BS并接受内镜干预治疗的患者的病历。收集了以下变量：患者人口统计学资料、临床表现、食管穿孔部位、主要干预措施、并发症及治疗结果。
在研究期间，共发现6例患者被诊断为BS。就诊时的中位年龄为55岁。男性4例，女性2例。最常见的穿孔部位是食管远端。最常见的症状是在呕吐或干呕发作后出现胸痛（67%）。4例患者（66.7%）发生感染性休克。所有患者（100%）的主要干预措施均为内镜下置入全覆膜食管支架。所有病例均咨询介入放射科进行液体引流和放置胸管。所有患者（100%）的BS均临床治愈，无需后续手术干预。研究组内无死亡病例，平均随访时间为2年。
内镜治疗似乎是BS患者的一种有效治疗策略。我们还注意到，对于出现脓毒症的患者，治疗效果令人满意，这可能是由于在介入放射科的指导下进行了紧急液体引流。
