The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Bayram, Ahmet Sami; Erol, Mehmet Muharrem; Melek, Hüseyin; Colak, Mehmet Ali; Kermenli, Tayfun; Gebitekin, Cengiz

doi:10.5152/eajm.2014.55

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…TOM is the most crucial factor that influences the outcome of EP [15,16]. In our study, patients with late TOM had significantly higher rates of ICU admission, organ support need, reintervention, mean hospital stay, and morbidity.…”

Section: Discussionsupporting

confidence: 48%

A - 13 Years of Single-Center Experience in the Management and Outcome of Esophageal Perforation

Alawady

Elsharawy

Mansour

et al. 2022

Zagazig University Medical Journal

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Objective: Esophageal perforation (EP) is a fatal status that continues to be challenging the management, with the incidence of mortality and morbidity has been reported to reach 40%. Its diagnosis may be tricky as it usually presents with a wide range of non-specific symptoms. Our study aims to report characteristics, relay our experience with EP management, and evaluate the various strategies used. Methods: This study retrospectively evaluated the management of 53 patients with EP over 13 years. The confirmed diagnosis was established by esophagogram with water-soluble contrast, contrast-enhanced computed tomography, and esophagus-gastro-duodenoscopy. Initial management was categorized as conservation, endoscopic stent, or surgery. Re-intervention and different outcomes were recorded and analyzed. Results: Thoracic EP is the most common location (71.7%). The most common cause of EP was iatrogenic (35.8%). About 58.5% of patients were diagnosed ≤ 24 hours. The mean Pittsburg severity score was 7.5. The initial management was conservation (35.8%), an endoscopic stent (17%), and surgical intervention (47.2%). ICU and organ support were needed in 35.8% and 20.8%, respectively. The mean hospital stay for all patients was 27.7 days. Morbidity and mortality were recorded at 30.2% and 18.9%, respectively. Conclusion: EP management should be flexible with a tailored strategy for every patient. Etiology, site, severity score, time to management, and patient reserve are significant factors in management and prognosis.

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Section: Discussionsupporting

confidence: 48%

A - 13 Years of Single-Center Experience in the Management and Outcome of Esophageal Perforation

Alawady

Elsharawy

Mansour

et al. 2022

Zagazig University Medical Journal

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“…Regardless of the etiology, severe esophageal perforation is a surgical emergency since patients can initially appear stable, but then decompensate quickly. [97][98][99][100] Decompensation usually results from esophageal and gastric contents leaking into the mediastinum with resultant necrotizing inflammation, sepsis, and ultimately multiorgan failure and death. 101,102 The Esophagus and Regenerative Medicine…”

Section: Esophageal Injurymentioning

confidence: 99%

Regenerative Medicine Strategies for Esophageal Repair

Londoño

Badylak

2015

Tissue Engineering Part B: Reviews

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Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside.

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“…Although there is no consensus on optimal management strategy, it is well established that prompt diagnosis and treatment within 24 hours of the perforation is associated with improved outcomes (1,(3)(4)(5)(6)(7)(8). In a metanalysis of 75 studies, Biancari et al (8) found a pooled mortality of 11.9%, however patients treated within 24 hours had a mortality of 7.4%, whilst those treated after 24 hours had a mortality of 20.3% (risk ratio 2.279, 95% CI, 1.632-3.182).…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic oesophageal perforation

Rozwadowski¹,

Internullo²

2021

Shanghai Chest

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Oesophageal perforation can be a devastating injury, associated with high morbidity and mortality. Known causes include iatrogenic, spontaneous, traumatic and foreign bodies. Iatrogenic perforations remain the most common. Early diagnosis is vital but difficult, as symptoms are often nonspecific and sometimes relatively mild. Therefore, a high index of suspicion is important, especially after any oesophageal instrumentation or intra-thoracic surgery. The presentation of oesophageal perforation can vary significantly. Timing of diagnosis, presence of systemic symptoms, underlying oesophageal pathology, site and size of perforation influence management. In the lack of evidence, management options vary and there is not one recognized optimum treatment strategy, however there is consensus that oesophageal perforations managed within 24 hours have significantly better outcomes. Historically, the mainstay of treatment has been surgical, with methods including drainage and primary repair, exclusion and diversion techniques, and oesophagectomy. In carefully selected patients with a prompt diagnosis and no systemic symptoms a conservative approach has been successful. This includes fluid resuscitation, intravenous antimicrobials, nothing-by-mouth, gastric decompression and parenteral nutrition. Endoscopic clipping, suturing or stenting have gained popularity in the last couple of decades and are now established approaches in selected patients, as an alternative or in combination with surgery. Novel treatments include the use of endoscopic vacuumassisted therapy (EVT). This review outlines the current approach to iatrogenic oesophageal perforation.

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The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Cited by 11 publications

References 18 publications

A - 13 Years of Single-Center Experience in the Management and Outcome of Esophageal Perforation

A - 13 Years of Single-Center Experience in the Management and Outcome of Esophageal Perforation

Regenerative Medicine Strategies for Esophageal Repair

Iatrogenic oesophageal perforation

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