Interdisziplinäres Management der Ösophagusperforation

Herbold, Till; Hölscher, A.; Chon, SH; Maus, Marcela V.; Schmidt, H; Brinkmann, S; Bludau, M; Leers, Jessica M.; Gütschow, C.; Schröder, W.

doi:10.1055/s-0035-1559500

Cited by 2 publications

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“…25,27 The review of the previous literature shows a very heterogeneous distribution of therapeutic strategies due to the lack of both a grading of the perforation and a proposal as a guiding structure for the therapeutic decision. 3,4,7,9,10,11,13,15,17,18,19,21,22,26 There was no grade classi cation in any of the studies. Comparability of the studies is therefore not given.…”

Section: Discussionmentioning

confidence: 98%

Classification of the oesophageal perforation

Harrich

Knoefel

Bölke

et al. 2023

Preprint

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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.

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Section: Discussionmentioning

confidence: 98%

Classification of the oesophageal perforation

Harrich

Knoefel

Bölke

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The review of the previous literature shows a very heterogeneous distribution of therapeutic strategies due to the lack of both a grading of the perforation and a standardized process to form the therapeutic decision [ 3 , 4 , 7 , 9 – 11 , 12 , 13 , 15 – 18 , 20 , 21 , 25 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Classification of the oesophageal perforation

Harrich,

Knoefel,

Bölke

et al. 2024

Eur J Med Res

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Objectives Esophageal perforations are a complex clinical scenario that have been poorly studied. To date, there is no grading of esophageal perforations, the reason being that the outcome is very heterogeneous, because the perforation is very heterogeneous. A grading of the severity of the perforation may guide treatment, and could ultimately affect morbidity and mortality. Methods The observation period of the study was four years. All patients with a perforation of the esophagus aged 18 to 90 years were included. All anastomotic insufficiencies or fistulas after surgery of the esophagus were excluded. The cause of the injury and the time interval between the event and the start of therapy were analyzed. The severity of each perforation was classified based on the results of a diagnostic CT scan, gastroscopy as well as clinical and laboratory findings. Therapy and signs of infection were evaluated. Endpoints of the study were patient recovery or death. The study was conducted as a retrospective single-center study at a university hospital of Düsseldorf. The study has been approved by the review board. Patients gave their informed consent before data collection. All data were analyzed using SPSS 29 (IBM SPSS Statistics software). Results Age, gender and cause of the esophageal perforation did not impact significantly on overall survival. The duration of injury > 24 h (p = 0.01), presence of mediastinitis (p = 0.01) and necrosis of the esophagus (p = 0.02) were associated with an unfavorable outcome. The correlation of the clinical grading of the severity of the perforation based on the endoscopic, radiological and clinical findings with the overall survival of patients was significant. Patients categorized into the four grades of severity (I–IV) had an overall survival of 100%, 100%, 70% and 50%, respectively. Conclusion The severity of esophageal perforations can be systematically rated grades I to IV based on the radiological, endoscopic and clinical findings at diagnosis. Due to the grading and its correlation to the overall survival, a comparison of patients, their treatment and outcome becomes possible. In future, the grade of a perforation may guide treatment, and therefore affect morbidity and mortality.

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Interdisziplinäres Management der Ösophagusperforation

Cited by 2 publications

References 0 publications

Classification of the oesophageal perforation

Classification of the oesophageal perforation

Classification of the oesophageal perforation

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