Predictors of Morbidity and Mortality in Esophageal Perforation: Retrospective Study of 80 Patients

Zimmermann, Markus; Hoffmann, Martin; Jungbluth, Thomas; Bruch, Hans–Peter; Keck, Tobias; Schloericke, Erik

doi:10.1177/1457496916654097

Cited by 34 publications

(30 citation statements)

References 31 publications

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“…[11][12][13] The rate of iatrogenic injury is increased with endoscopic examinations, placement of tubes, stent application, submucosal dissection, and endomucosal resection and up to 60% in the most recent series. [1] Furthermore, there is substantial heterogeneity in the etiologies of perforation including Boerhaave syndrome, tumor perforation, thoracic trauma, swallowing foreign bodies, and acid or caustic substances. [14][15][16] In our study, the rate of iatrogenic perforation was 53.8% and spontaneous perforation was 38.5%.…”

Section: Discussionmentioning

confidence: 99%

“…The most common presenting symptoms of EP are thoracic pain (58%), dyspnea (30%), dysphagia (24%), vomiting and nausea (21%), coughing (9%), and hypovolemic shock (11%). [1] Malignancy is the most frequently identified underlying pathology. CT is the most commonly used diagnostic tool in all perforation etiologies.…”

Section: Diagnostic Toolsmentioning

confidence: 99%

“…The mortality and morbidity rates were reported up to 40%. [1,2] The most common cause of death in patients with EP is sepsis, which leads to multiorgan failure. [3] The esophagus has no serosal surface; thus, thoracic perforations could cause dissemination of the surrounding tissues and lead to mediastinitis.…”

Section: Introductionmentioning

confidence: 99%

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A 4-year single-center experience in management of esophageal perforation

Sarı¹

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Esophageal perforation (EP) is a lethal surgical emergency that needs to be diagnosed and treated immediately. Diagnosis and treatment options for EP are limited due to its lower incidence. There are scoring systems proposed for this purpose; however, they cannot be applied to every patient. The recent trend in the treatment of EP is toward the non-operative approach over the surgical treatment methods. The purpose of the present study was to evaluate our treatment methods and outcomes in patients with EP. METHODS: Thirteen patients with EP treated in our clinic between 2013 and 2017 were retrospectively reviewed. The Pittsburgh Perforation Severity Score (PSS), systemic condition status, and Clavien-Dindo Classification (CDC) score were assessed, and treatment methods were reviewed. Their effects on morbidity and mortality were examined using Fisher's exact test and biserial correlation test. RESULTS: A total of 13 patients (six males and seven females; median age 64 years) were included in the study. Ten patients were managed non-operative, and three were treated surgically. Of the 10 patients, two had additional surgery after non-operative management. The PSS, systemic condition status, CDC score, duration of stay in the hospital, time to diagnosis, presence of hypotension, and being in shock were strongly correlated with mortality (p<0.05). The PSS, CDC score, and stay in the intensive care unit were strongly correlated with morbidity (p<0.05). The comparison between the non-operative and operative groups did not yield a statistically significant difference in mortality and morbidity. CONCLUSION: Even if the scoring systems help to understand the severity of the condition, they are inadequate to determine the treatment option. Early diagnosis and treatment are the most important steps in management. Operative and non-operative treatment options are not superior to each other, but their complementary use will be more beneficial for the patients.

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Section: Discussionmentioning

confidence: 99%

Section: Diagnostic Toolsmentioning

confidence: 99%

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A 4-year single-center experience in management of esophageal perforation

Sarı¹

2018

Ulus Travma Acil Cerrahi Derg

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“…heterogeneity in the patient populations and therapeutic management [51, 95 -100]. Nonsurgical management seemed to be related to a lower rate of morbidity [51,95]. A 12-year English multicenter retrospective study including 2564 patients with esophageal perforation (152 cases with iatrogenic perforation) revealed that high hospital case volume was associated with significant reductions in 30-day mortality (OR 0.68, P = 0.001) and 90-day mortality (OR 0.69, P = 0.001) [101].…”

Section: Treatment: Esophagusmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

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“…In adults endoscopy with stent placement has been advocated as a minimally invasive procedure to preserve the patient's esophagus [8,11,15,22,26,28]. Most recently, the use of fully covered self-expandable metal stents (SEMSs) has been reported with different outcome for benign esophageal disorders in children [2,4,7,17,19,24].…”

Section: Introductionmentioning

confidence: 99%

Experience with Fully Covered Self-Expandable Metal Stents for Esophageal Leakage in Children

et al. 2019

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Background There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for the treatment of esophageal leakage particularly in infants and neonates. Methods Eight patients (5M, 3F) with a median age of 17 months (range, 1–135 months) who underwent treatment with SEMSs for an anastomotic leakage or perforation of the esophagus were recruited to this retrospective study. Four children were born premature. In six patients the stents were placed primarily as an emergency procedure. Results Median duration of individual stent placement was 42 days (range, 13–72 days). Six out of eight patients (75%) were treated with one stent only. In three preterm infants who had their stents inserted within the first month relative weight gain was 17% compared with 2% in five patients who were treated later in life (p=0.0986). In four cases (50%) distal migration of the stent was observed. Seven out of eight patients (88%) had their leakage resolved after stent therapy. Conclusions Insertion of fully covered SEMSs is an alternative tool for the treatment of esophageal leakage in children and preterm infants, and successful with only one single application in selected cases. It can be used either following previous therapy or as part of an emergency procedure. Because of the absence of manufactured, age-related devices SEMSs that are originally designed for other organs can be applied.

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Predictors of Morbidity and Mortality in Esophageal Perforation: Retrospective Study of 80 Patients

Abstract: Intraluminal perforations, rapid initiation of therapy, and non-operative treatment were associated with favorable outcomes. The perforation site did not have an impact on outcomes. Esophageal resection was associated with high mortality.

Cited by 34 publications

References 31 publications

A 4-year single-center experience in management of esophageal perforation

A 4-year single-center experience in management of esophageal perforation

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Experience with Fully Covered Self-Expandable Metal Stents for Esophageal Leakage in Children

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