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World Journal of Emergency Surgery :... 2019The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified... (Review)
Review
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
Topics: Caustics; Esophageal Perforation; Esophagoscopy; Esophagus; Foreign Bodies; Humans; Tomography, X-Ray Computed
PubMed: 31164915
DOI: 10.1186/s13017-019-0245-2 -
Journal of Visceral Surgery Jun 2010The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite... (Review)
Review
The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy.
Topics: Debridement; Diagnosis, Differential; Drainage; Endoscopy, Digestive System; Esophageal Diseases; Esophageal Perforation; Esophagectomy; Foreign Bodies; Humans; Iatrogenic Disease; Mediastinal Diseases; Prognosis; Stents; Surgical Flaps; Survival Rate; Suture Techniques; Tomography, X-Ray Computed
PubMed: 20833121
DOI: 10.1016/j.jviscsurg.2010.08.003 -
Internal Medicine (Tokyo, Japan) Jan 2022
Topics: Esophageal Diseases; Esophageal Perforation; Humans; Mediastinal Diseases; Rupture, Spontaneous
PubMed: 34219113
DOI: 10.2169/internalmedicine.7807-21 -
Langenbeck's Archives of Surgery Mar 2022Esophageal perforation is associated with high morbidity and mortality. In addition to surgical treatment, endoscopic endoluminal stent placement and endoscopic vacuum...
PURPOSE
Esophageal perforation is associated with high morbidity and mortality. In addition to surgical treatment, endoscopic endoluminal stent placement and endoscopic vacuum therapy (EVT) are established methods in the management of this emergency condition. Although health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic intervention, not much is known about HRQoL, particularly in the long-term follow-up of patients treated for non-neoplastic esophageal perforation with different treatment strategies. The aim of this study was to evaluate patients' outcome after non-neoplastic esophageal perforation with focus on HRQoL in the long-term follow-up.
METHODS
Patients treated for non-neoplastic esophageal perforation at the University Hospital Cologne from January 2003 to December 2014 were included. Primary outcome and management of esophageal perforation were documented. Long-term quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI), the Health-Related Quality of Life Index (HRQL) for patients with gastroesophageal reflux disease (GERD), and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires for general and esophageal specific QoL (QLQ-C30 and QLQ-OES18).
RESULTS
Fifty-eight patients were included in the study. Based on primary treatment, patients were divided into an endoscopic (n = 27; 46.6%), surgical (n = 20; 34.5%), and a conservative group (n = 11; 19%). Short- and long-term outcome and quality of life were compared. HRQoL was measured after a median follow-up of 49 months. HRQoL was generally reduced in patients with non-neoplastic esophageal perforation. Endoscopically treated patients showed the highest GIQLI overall score and highest EORTC general health status, followed by the conservative and the surgical group.
CONCLUSION
HRQoL in patients with non-neoplastic esophageal perforation is reduced even in the long-term follow-up. Temporary stent or EVT is effective and provides a good alternative to surgery, not only in the short-term but also in the long-term follow-up.
Topics: Esophageal Neoplasms; Esophageal Perforation; Esophagectomy; Follow-Up Studies; Humans; Quality of Life; Surveys and Questionnaires; Treatment Outcome
PubMed: 34562118
DOI: 10.1007/s00423-021-02327-1 -
Medicine Apr 2021Esophageal perforation has been one of the serious clinical emergencies, because of the high mortality and complication rates. However, the current prognosis of...
BACKGROUND
Esophageal perforation has been one of the serious clinical emergencies, because of the high mortality and complication rates. However, the current prognosis of esophageal perforation and the outcomes of available treatment methods are not well defined. This study attempted to pool the immediate outcomes of esophageal perforation in the past 2 decades.
METHODS
The clinical data of 22 consecutive adult patients with esophageal perforation in our center were analyzed. A pooled analysis was also conducted to summarize results from the literatures published between 1999 and 2020. Studies that met the inclusion criteria were assessed, and their methodological quality was examined.
RESULTS
The mortality and complication rates in our center were 4.55% and 31.82%, separately. The pooled analysis included 45 studies published between 1999 and 2019, which highlighted an overall immediate mortality rate of 9.86%. Surgical treatments were associated with a pooled immediate mortality of 10.01%, and for conservative treatments of 6.49%. Besides, in the past decade, the mortality and complication rates decreased by 27.12% and 46.75%, respectively.
CONCLUSIONS
In the past 2 decades, the overall immediate mortality rate of esophageal perforation was about 10% in the worldwide, and the outcomes of esophageal perforation treatment are getting better in the last 10 years.
ETHICS REGISTRATION INFORMATION
LW2020011.
Topics: Adult; Aged; Aged, 80 and over; Conservative Treatment; Esophageal Perforation; Esophagoscopy; Female; Humans; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 33879724
DOI: 10.1097/MD.0000000000025600 -
Journal of Cardiothoracic Surgery Oct 2021Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning...
BACKGROUND
Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients.
METHODS
For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management.
RESULTS
The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential.
CONCLUSIONS
The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study.
TRIAL REGISTRATION
Not applicable.
Topics: Esophageal Perforation; Foreign Bodies; Humans; Prognosis; Retrospective Studies; Rupture
PubMed: 34627308
DOI: 10.1186/s13019-021-01680-y -
CMAJ : Canadian Medical Association... Sep 2021
Topics: Alcohol Drinking; Esophageal Perforation; Humans; Hydropneumothorax; Male; Mediastinal Diseases; Mediastinal Emphysema; Middle Aged; Vomiting
PubMed: 34580144
DOI: 10.1503/cmaj.202893 -
Clinical and Translational... Jan 2022Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this...
INTRODUCTION
Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this study was to investigate the safety and efficacy of nonoperative treatment of esophageal perforation caused by foreign bodies.
METHODS
We retrospectively analyzed 270 patients admitted to our hospital for esophageal perforation caused by foreign bodies from January 2012 to December 2020, all of whom received nonoperative treatment.
RESULTS
The mean age of the patients was 56 ± 17 years, and fish bones were the most common type of foreign body. A total of 61.2% of the perforations were in the cervical esophagus. All patients received nonoperative treatment initially, and the foreign body removal rate using endoscopy reached 97%. The perforation healing rate reached 94.8%, whereas 3 patients (1.1%) died during hospitalization. The median (range) duration of hospitalization was 4 days (3-6). Multivariable analysis showed age ≥ 66 years (odds ratio [OR]: 2.196; 95% confidence interval [CI]: 1.232-3.916; P = 0.008), men (OR: 1.934; 95% CI: 1.152-3.246; P = 0.013), and time to treatment (OR: 1.126; 95% CI: 1.027-1.233; P = 0.011) were independent risk factors for infection, whereas the risk of infection was lower when the foreign body type was fish bone (OR: 0.557; 95% CI: 0.330-0.940; P = 0.028).
DISCUSSION
Nonoperative treatment is safe and effective for esophageal perforation caused by foreign bodies. Even if perforation is combined with infection, active nonoperative treatment can still achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.
Topics: Adult; Aged; Endoscopy; Esophageal Perforation; Foreign Bodies; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 35060929
DOI: 10.14309/ctg.0000000000000451 -
Monaldi Archives For Chest Disease =... Feb 2021Esophageal perforation is a fatal entity if not diagnosed in a timely fashion. Once diagnosed, it requires collaborative effort of team of doctors including...
Esophageal perforation is a fatal entity if not diagnosed in a timely fashion. Once diagnosed, it requires collaborative effort of team of doctors including radiologists, thoracic surgeons and general surgeons. We share hereby our experience with esophageal perforation and successful outcome.
Topics: Esophageal Perforation; Humans
PubMed: 33567816
DOI: 10.4081/monaldi.2021.1443 -
Journal of Clinical Gastroenterology Oct 2017To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation.
GOALS
To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation.
BACKGROUND
Esophageal perforation is a serious complication of EoE.
MATERIALS AND METHODS
We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation.
RESULTS
Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair.
CONCLUSIONS
Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.
Topics: Administration, Oral; Adolescent; Adult; Barium Sulfate; Chi-Square Distribution; Child; Contrast Media; Deglutition; Deglutition Disorders; Eosinophilic Esophagitis; Esophageal Perforation; Esophageal Stenosis; Esophagoscopy; Esophagus; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; North Carolina; Odds Ratio; Predictive Value of Tests; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 27680593
DOI: 10.1097/MCG.0000000000000718