No abstract

No abstract

Background: Esophageal perforations can occur spontaneously, but most are iatrogenic and related to procedures. The literature reports death rates from 10% to 26%. Our goals were to summarize demographics, comorbidities, managing services, perforation sites, outcomes, and complications of esophageal perforations at a tertiary academic medical center. Methods: This was a retrospective chart review. ICD and CPT codes were used to identify 89 subjects who experienced esophageal perforation from 2008 to 2020. Patients under age 18 were excluded from the study. Results: Patients diagnosed with esophageal perforation averaged 67 years. Perforations affected more males than females. Most perforations were contained and referred from outside hospitals. Thoracic esophageal perforations predominated followed by cervical and abdominal. Iatrogenic causes were identified in 56% of cases. The most common underlying diseases were gastrointestinal, cardiac, and cancer. Most patients were managed by a multidisciplinary team. The most common complication was empyema managed with chest tubes. Conclusions: We report an esophageal perforation mortality rate of 9%. Approximately 1% of perforations directly led to death. All uncontained thoracic perforations were complicated by empyema and managed with chest tubes. We observed more contained versus uncontained perforations, which may have contributed to higher survival rate. Our institution’s multidisciplinary approach to managing perforations potentially contributed to better outcomes and increased survival. Esophageal perforation remains a medical emergency, but perhaps with prompt recognition and interdisciplinary management, outcomes may not be as dreadful as previously reported.

No abstract

Objectives Hemorrhagic pancreatic fluid collections (hPFC) are a complication of pancreatitis with an unknown influence on prognosis. Advancements in endoscopic management of PFC have improved results over their surgical and percutaneous alternatives. We performed a propensity‐matched analysis comparing clinical outcomes in hemorrhagic and non‐hemorrhagic PFC (nhPFC). Methods From November 2015 to November 2021, a retrospective comparative cohort analysis was performed comparing clinical outcomes for patients with hPFC and nhPFC managed with lumen‐apposing metal stents. Propensity score matching was used to balance the two subgroups. Wilcoxon two‐sample tests were used to compare continuous variables and Fisher's exact test was used to compare categorical variables. Kaplan‐Meier method was used to estimate overall survival. Results Fifteen patients with hPFC were matched with 30 nhPFC patients. Technical and clinical success was similar in both groups. The median length of hospitalization was 6 days in the hPFC group and 3 days in the nhPFC group ( p = 0.23); however, more hPFC patients required intensive care unit admission post‐procedure (33.3% vs. 16.7%, p = 0.26). Patients with hPFC were more likely to be readmitted to the hospital within 30 days (33.3% vs. 6.7%, p = 0.032). Mortality at 3 months (13% vs 3%, p = 0.25) and 6 months (27% vs. 7%, p = 0.09) was higher in the hPFC cohort. The 1‐year survival estimate was 73.3% (standard error = 11.4) in the hPFC group and 88.9% (6.1) in the nhPFC group ( p = 0.16). Conclusions Patients with hPFC are more likely to be readmitted to the hospital within 30 days and have worse clinical outcomes.