Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta‐Analysis of 75 Studies
- 26 February 2013
- journal article
- review article
- Published by Wiley in World Journal of Surgery
- Vol. 37 (5), 1051-1059
- https://doi.org/10.1007/s00268-013-1951-7
Abstract
The current prognosis of esophageal perforation and the efficacy of available treatment methods are not well defined. We performed a systematic review of esophageal perforations published from January 2000 to April 2012 and subjected a proportion of the retrieved data to a meta-analysis. Meta-regression was performed to determine predictors of mortality immediately after esophageal perforation. Analysis of 75 studies resulted in a pooled mortality of 11.9 % [95 % confidence interval (CI) 9.7–14.3: 75 studies with 2,971 patients] with a mean hospital stay of 32.9 days (95 % CI 16.9–48.9: 28 studies with 1,233 patients). Cervical perforations had a pooled mortality of 5.9 %, thoracic perforations 10.9 %, and intraabdominal perforations 13.2 %. Mortality after esophageal perforation secondary to foreign bodies was 2.1 %, iatrogenic perforation 13.2 %, and spontaneous perforation 14.8 %. Treatment started within 24 h after the event resulted in a mortality rate of 7.4 % compared with 20.3 % in patients treated later (risk ratio 2.279, 95 % CI 1.632–3.182). Primary repair was associated with a pooled mortality of 9.5 %, esophagectomy 13.8 %, T-tube or any other tube repair 20.0 %, and stent-grafting 7.3 %. Results of recent studies indicate that mortality after esophageal perforation is high despite any definitive surgical or conservative strategy. Stent-grafting is associated with somewhat lower mortality rates, but studies may be biased by patient selection and limited experience.This publication has 83 references indexed in Scilit:
- Fluoroscopically Guided Balloon Dilation of Benign Esophageal Strictures: Incidence of Esophageal Rupture and Its Management in 589 PatientsAmerican Journal of Roentgenology, 2011
- Aggressive Surgical Treatment in Late-Diagnosed Esophageal Perforation: A Report of 11 CasesISRN Surgery, 2011
- A successful strategy for surgical treatment of Boerhaave’s syndromeSurgical Endoscopy, 2011
- Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndromeSurgical Endoscopy, 2011
- Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patientsBMC Surgery, 2010
- Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single centerJournal of Cardiothoracic Surgery, 2010
- Surgical Management of Boerhaave's Syndrome in a Tertiary Oesophagogastric CentreThe Annals of The Royal College of Surgeons of England, 2009
- Treatment of Esophageal Perforation in a Referral Center in TaiwanSurgery Today, 2005
- Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal herniaSurgical Endoscopy, 2001
- Management of Esophageal PerforationSurgery Today, 2001