Short- and long-term outcome of esophageal perforation

Sawyer, Richard; Phillips, Clay E.; Vakil, Nimish

doi:10.1016/s0016-5107(05)80594-2

Cited by 49 publications

(20 citation statements)

References 13 publications

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“…However, after surgery, a diagnosis of perforation is often difficult to establish, and, in other cases, diagnosis depends on the physician's alertness. 27 The classic treatment options include surgical repair, esophagectomy, or cervical exclusion. Primary surgical closure and mediastinal drainage within 24 hours of the injury have shown to improve survival rates.…”

Section: Discussionmentioning

confidence: 99%

Closure of Benign Leaks, Perforations, and Fistulas With Temporary Placement of Fully Covered Metal Stents

Orive-Calzada

Calderón-García

Bernal-Martínez

et al. 2014

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Section: Discussionmentioning

confidence: 99%

Closure of Benign Leaks, Perforations, and Fistulas With Temporary Placement of Fully Covered Metal Stents

Orive-Calzada

Calderón-García

Bernal-Martínez

et al. 2014

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The diagnosis of perforation or leakage after surgery often is difficult to establish depending on physician alertness. Every disturbance of the normal postoperative or postinterventional course or any history of vomiting before chest or abdominal pain should alert physicians to suspect esophageal perforation or leakage [13,16,17]. Contrast studies may need to be repeated because they sometimes are negative in the early stages after perforation [17].…”

Section: Discussionmentioning

confidence: 99%

Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks

2009

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“…Thoracic perforation typically presents as substernal chest pain, often with a component of pleurisy. Pleural effusions are present in 50% of thoracic perforations, and mediastinitis is more likely to occur 19. Hamman's sign, a finding characterized by an audible crunch with chest auscultation, is suggestive of mediastinal emphysema.…”

Section: Signs and Symptomsmentioning

confidence: 99%

“…1 and 2). 20–22 Results of contrast studies may be negative and warrant repeating within several hours 19…”

Section: Diagnosismentioning

confidence: 99%

Esophageal perforation as a complication of esophagogastroduodenoscopy

Bhatia

Collins

Nguyen

et al. 2008

Journal of Hospital Medicine

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Fifty years ago, esophageal perforation was common after rigid upper endoscopy.The arrival of flexible endoscopic instruments and refinement in technique have decreased its incidence; however, esophageal perforation remains an important cause of morbidity and mortality. This complication merits a high index of clinical suspicion to prevent sequelae of mediastinitis and fulminant sepsis. Although the risk of perforation with esophagogastroduodenoscopy alone is only 0.03%, this risk can increase to 17% with therapeutic interventions in the setting of underlying esophageal and systemic diseases. A wide spectrum of management options exist, ranging from conservative treatment to surgical intervention. Prompt recognition and management, within 24 hours of perforation, is critical for favorable outcomes. KEYWORDS: esophagogastroduodenoscopy, esophageal perforation, mediastinitis, sepsis, endoscopy. E sophagogastroduodenoscopy (EGD) carries a small but serious risk of esophageal perforation. Journal of Hospital Medicine1-3 With its potential for sepsis and fatal mediastinitis, prompt recognition and treatment are essential for favorable outcomes. The risk of perforation with diagnostic flexible EGD is 0.03%, which is an improvement from the 0.1%-0.4% risk associated with rigid endoscopy. 4 However, the risk of perforation can dramatically increase to 17% depending on the methods of therapeutic intervention and underlying risk factors (Table 1). 1,[5][6][7] It is estimated that 33%-75% of all esophageal perforations are iatrogenic. 8 Of those caused by EGD, therapeutic interventions portend an increased risk compared with the risk of diagnostic endoscopy alone (Table 2). 4 With the expanding role of flexible EGD and the increasing number of procedures performed, this modest risk per procedure still translates into a sizable number of perforations with their ensuing complications. 4,7 Mortality rates following esophageal perforation may approach 25%. 9 ANATOMY AND PATHOPHYSIOLOGYThe most common site of perforation is at the level of the cricopharyngeus, as it is a narrow introitus leading to the esophagus. The risk of perforation at this location is further increased with the presence of a Zenker's diverticulum or cervical osteophytes. The second most common site is proximal to the lower esophageal sphincter because of the angulation of the hiatus and the high frequency of esophageal webs, rings, reflux strictures, and hiatal

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Short- and long-term outcome of esophageal perforation

Cited by 49 publications

References 13 publications

Closure of Benign Leaks, Perforations, and Fistulas With Temporary Placement of Fully Covered Metal Stents

Closure of Benign Leaks, Perforations, and Fistulas With Temporary Placement of Fully Covered Metal Stents

Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks

Esophageal perforation as a complication of esophagogastroduodenoscopy

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