The impact of modified esophageal stenting on oral intake in delayed spontaneous esophageal perforation

Spontaneous esophageal perforation, commonly referred to as Boerhaave syndrome, is a rare but life-threatening condition with a high mortality rate. Delayed diagnosis is common due to nonspecific symptoms, and optimal treatment remains challenging. This study evaluates the outcomes of a modified esophageal stenting technique in patients with a delayed diagnosis. This retrospective study analyzed 18 patients treated for spontaneous esophageal perforation at a tertiary medical center between July 2012 and July 2022. Patients were divided into early (< 24 h) and delayed (≥ 24 h) diagnosis groups. A modified esophageal stenting approach, which combined fully covered self-expandable metal stent (FCSEMS) placement across the esophagogastric junction with minimally invasive drainage and external fixation, was applied in selected delayed cases. Outcomes were compared between the treatment strategies. Among the 11 patients in the delayed group, 5 underwent modified esophageal stenting. These patients had significantly lower Charlson Comorbidity Index scores and shorter operative durations compared to those receiving other treatments. Although the overall complication and mortality rates were higher in the delayed group (45.5% and 18.2%, respectively), patients treated with modified stenting were more likely to resume oral nutrition at discharge (p = 0.048), without an increase in hospital stay or postoperative complications. Modified esophageal stenting is a promising, less invasive option for managing delayed spontaneous esophageal perforation, facilitating earlier recovery without compromising safety.