Classification of the oesophageal perforation

Abstract

Objectives Oesophageal perforations are a complex clinical scenario that has been poorly studied. To date, there is no staging of oesophageal perforation. The outcome is often fatal and heterogeneous, which is related to the fact that there is no classification and no treatment guideline. Methods The observation period of the study covered a period of four years. The cause of the injury and the time interval between the event and the start of therapy were analyzed. Therapy and the clinical signs of infection were evaluated. Endpoints of the study were patient recovery or death due to sepsis. The study was conducted as a retrospective single-center study in a maximum-care hospital and has been approved by the review board. Patients gave informed consent before data collection. All data were analyzed using SPSS (IBM SPSS Statistics software). Results For this study, oesophageal perforation cases from a maximum care hospital were summarized and classified for the first time, from which a prediction of lethality could be derived. The proposed endoscopic radiological classification correlated with survival in our study. Accordingly, we were able to suggest a therapeutic option to the different stages. It can be seen that lethality correlates significantly with the severity of the perforation. As a final result of the study a prediction of mortality at diagnosis is now possible. Conclusion Oesophageal perforations can be systematically classified into grades I to IV, with grade III divided into a, b, and c according to the height of the perforation in relation to the anatomy. A treatment guideline can now be discussed according to the severity of the perforation.