nach oben

Erschienen in:

01.05.2013

Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta-Analysis of 75 Studies

verfasst von: Fausto Biancari, Vito D’Andrea, Rosalba Paone, Carlo Di Marco, Grazia Savino, Vesa Koivukangas, Juha Saarnio, Ersilia Lucenteforte

Erschienen in: World Journal of Surgery | Ausgabe 5/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

The current prognosis of esophageal perforation and the efficacy of available treatment methods are not well defined.

Methods

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.

Results

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 %.

Conclusions

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.

Nur mit Berechtigung zugänglich

Barrett NR (1947) Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg 35:216–218PubMedCrossRef

Koivukangas V, Biancari F, Meriläinen S et al (2012) Esophageal stenting for spontaneous esophageal perforation. J Trauma 73:1011–1013CrossRef

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCrossRef

Freeman MF, Tukey JW (1950) Transformations related to the angular and the square root. Ann Math Stat 21:607–611CrossRef

R Development Core Team (2001) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. Available at: http://www.R-project.org. Accessed May 2012

Brodley CE, Lau J, Schmid CH et al (2012) Open meta-analyst. Available at: http://tuftscaes.org/open_meta. Accessed May 2012

Abbas G, Schuchert MJ, Pettiford BL et al (2009) Contemporaneous management of esophageal perforation. Surgery 146:749–756PubMedCrossRef

Amir AI, van Dullemen H, Plukker JTM (2004) Selective approach in the treatment of esophageal perforations. Scand J Gastroenterol 39:418–422PubMedCrossRef

Amudhan A, Rajendran S, Raj VV et al (2009) Management of esophageal perforation: experience from a tertiary center in India. Dig Surg 26:322–328PubMedCrossRef

10.

Andrade-Alegre R (2005) Surgical treatment of traumatic esophageal perforations: analysis of 10 cases. Clinics (Sao Paulo) 60:375–380CrossRef

11.

Ayed AK, Al-Din HJ, Asfar SK (2000) Reinforced primary repair of early distal oesophageal perforation. Eur J Surg 166:938–941PubMedCrossRef

12.

Ben-David K, Lopes J, Hochwald S et al (2011) Minimally invasive treatment of esophageal perforation using a multidisciplinary treatment algorithm: a cases series. Endoscopy 43:160–162PubMedCrossRef

13.

Breigeiron R, de Souza HP, Sidou JP (2008) Risk factors for surgical site infection after surgery for esophageal perforation. Dis Esophagus 21:266–271PubMedCrossRef

14.

Bresadola V, Terrosu G, Favero A et al (2008) Treatment of perforation in the healthy esophagus: analysis of 12 cases. Langenbecks Arch Surg 393:135–140PubMedCrossRef

15.

Chao YK, Liu YH, Ko PJ et al (2005) Treatment of esophageal perforation in a referral center in Taiwan. Surg Today 35:828–832PubMedCrossRef

16.

Chen M, Ling Y, Yang B (2010) Management of late cervical esophageal perforation. Turkish J Trauma Emerg Surg 16:511–515

17.

Cho S, Jheon S, Ryu KM et al (2008) Primary esophageal repair in Boerhaave’s syndrome. Dis Esophagus 21:660–663PubMedCrossRef

18.

Cho JS, Kim YD, Kim JW et al (2011) Thoracoscopic primary esophageal repair in patients with Boerhaave’s syndrome. Ann Thorac Surg 91:1552–1555PubMedCrossRef

19.

Daniel M, Kamani T, Nogueira C et al (2010) Perforation after rigid pharyngo-oesophagoscopy: When do symptoms and signs develop? J Laryngol Otol 124:171–174PubMedCrossRef

20.

D’Cunha J, Rueth NM, Groth SS et al (2011) Esophageal stents for anastomotic leaks and perforations. J Thorac Cardiovasc Surg 142:39–46PubMedCrossRef

21.

Di Franco F, Lamb PJ, Karat D et al (2008) Iatrogenic perforation of localized oesophageal cancer. Br J Surg 95:837–839PubMedCrossRef

22.

Erdogan A, Gurses G, Keskin H et al (2007) The sealing effect of a fibrin tissue patch on the esophageal perforation area in primary repair. World J Surg 31:2199–2203. doi:10.1007/s00268-007-9207-z PubMedCrossRef

23.

Eroglu A, Turkyilmaz A, Aydin Y et al (2009) Current management of esophageal perforation: 20 years experience. Dis Esophagus 22:374–380PubMedCrossRef

24.

Fan Y, Song HY, Kim JH et al (2011) Fluoroscopically guided balloon dilation of benign esophageal strictures: incidence of esophageal rupture and its management in 589 patients. AJR Am J Roentgenol 197:1481–1486PubMedCrossRef

25.

Fischer A, Thomusch O, Benz S et al (2006) Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg 81:467–472PubMedCrossRef

26.

Freeman RK, Van Woerkom JM, Vyverberg A et al (2009) Esophageal stent placement for the treatment of spontaneous esophageal perforations. Ann Thorac Surg 88:194–198PubMedCrossRef

27.

Freeman RK, Van Woerkom JM, Ascioti AJ (2007) Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg 83:2003–2007PubMedCrossRef

28.

Furugaki K, Yoshida J, Hokazono K et al (2011) Esophageal ruptures: triage using the systemic inflammatory response syndrome score. Gen Thorac Cardiovasc Surg 59:220–224PubMedCrossRef

29.

Gaudinez RF, English GM, Gebhard JS et al (2000) Esophageal perforations after anterior cervical surgery. J Spinal Disord 13:77–84PubMedCrossRef

30.

Griffin SM, Lamb PJ, Shenfine J et al (2008) Spontaneous rupture of the oesophagus. Br J Surg 95:1115–1120PubMedCrossRef

31.

Griffiths EA, Yap N, Poulter J et al (2009) Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK. Dis Esophagus 22:616–625PubMedCrossRef

32.

Gupta NM, Kaman L (2004) Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 187:58–63PubMedCrossRef

33.

Hasan S, Jilaihawi AN, Prakash D (2005) Conservative management of iatrogenic oesophageal perforations: a viable option. Eur J Cardiothorac Surg 28:7–10PubMedCrossRef

34.

Haveman JW, Nieuwenhuijs VB, Kobold JP et al (2011) Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndrome. Surg Endosc 25:2492–2497PubMedCrossRef

35.

Hermansson M, Johansson J, Gudbjartsson T et al (2010) Esophageal perforation in South of Sweden: results of surgical treatment in 125 consecutive patients. BMC Surg 10:31PubMedCrossRef

36.

Horgan S, Galvani C, Gorodner MV et al (2005) Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg 9:1020–1029PubMedCrossRef

37.

Jethwa P, Lala A, Powell J, McConkey CC et al (2005) A regional audit of iatrogenic perforation of tumours of the oesophagus and cardia. Aliment Pharmacol Ther 21:479–484PubMedCrossRef

38.

Jiang J, Yu T, Zhang YF et al (2012) Treatment of cervical esophageal perforation caused by foreign bodies. Dis Esophagus 25:590–594PubMedCrossRef

39.

Johnsson E, Lundell L, Liedman B (2005) Sealing of esophageal perforation or ruptures with expandable metallic stents: a prospective controlled study on treatment efficacy and limitations. Dis Esophagus 18:262–266PubMedCrossRef

40.

Jougon J, Mc Bride T, Delcambre F et al (2004) Primary esophageal repair for Boerhaave’s syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg 25:475–479PubMedCrossRef

41.

Keeling WB, Miller DL, Lam GT et al (2010) Low mortality after treatment for esophageal perforation: a single center experience. Ann Thorac Surg 90:1669–1673PubMedCrossRef

42.

Kiernan PD, Sheridan MJ, Hettrick V et al (2006) Thoracic esophageal perforation: one surgeon’s experience. Dis Esophagus 19:24–30PubMedCrossRef

43.

Kiev J, Amendola M, Bouhaidar D et al (2007) A management algorithm for esophageal perforation. Am J Surg 194:103–106PubMedCrossRef

44.

Kollmar O, Lindemann W, Richter S et al (2003) Boerhaave’s syndrome: primary repair versus esophageal resection: case reports and meta-analysis of the literature. J Gastrointest Surg 7:726–734PubMedCrossRef

45.

Kumar P, Sarkar PK (2004) Late results of primary esophageal repair for spontaneous rupture of the esophagus (Boerhaave’s syndrome). Int Surg 89:15–20PubMed

46.

Kuppusamy MK, Hubka M, Felisky CD et al (2011) Evolving management strategies in esophageal peroration: surgeons using nonoperative techniques to improve outcomes. J Am Coll Surg 213:164–172PubMedCrossRef

47.

Lázár G Jr, Paszt A, Simonka Z et al (2011) A successful strategy for surgical treatment of Boerhaave’s syndrome. Surg Endosc 25:3613–3619PubMedCrossRef

48.

Leers JM, Vivaldi C, Schäfer H et al (2009) Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc 23:2258–2262PubMedCrossRef

49.

Linden PA, Bueno R, Mentzer SJ et al (2007) Modified T-tube repair of delayed esophageal perforation results in a low mortality rate similar to that seen with acute perforations. Ann Thorac Surg 83:1129–1133PubMedCrossRef

50.

Mahmodlou R, Abdirad I, Ghasemi-Rad M (2011) Aggressive surgical treatment in late-diagnosed esophageal perforation: a report of 11 cases. ISRN Surg. Article ID 868356. doi:10.5402/2011/868356

51.

Minnich DJ, Yu P, Bryant AS et al (2011) Management of thoracic esophageal perforations. Eur J Cardiothorac Surg 40:931–938PubMed

52.

Muir AD, White J, McGuigan JA et al (2003) Treatment and outcomes of oesophageal perforation in a tertiary referral centre. Eur J Cardiothorac Surg 23:799–804PubMedCrossRef

53.

Neel D, Davis EG, Farmer R et al (2010) Aggressive operative treatment for emetogenic rupture yields superior results. Am Surg 76:865–868PubMed

54.

Ökten I, Cangir AK, Özdmemir N et al (2011) Management of esophageal perforation. Surg Today 31:36–39

55.

Onat S, Ulku R, Cigdem KM et al (2010) Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center. J Cardiothorac Surg 5:46PubMedCrossRef

56.

Peng A, Li Y, Xiao Z et al (2012) Study of clinical treatment of esophageal foreign body-induced esophageal perforation with lethal complications. Eur Arch Otorhinolaryngol 269:2027–2033PubMedCrossRef

57.

Port JL, Kent MS, Korst RJ et al (2003) Thoracic esophageal perforations: a decade of experience. Ann Thorac Surg 75:1071–1074PubMedCrossRef

58.

Richardson JD (2005) Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg 190:161–165PubMedCrossRef

59.

Rosiere A, Mulier S, Khoury A et al (2003) Management of oesophageal perforation after delayed diagnosis: the merit of tissue flap reinforcement. Acta Chir Belg 103:497–501PubMed

60.

Rubikas R (2004) Pharyngeal and oesophageal injuries. Injury 35:371–378PubMedCrossRef

61.

Ryom P, Ravn JB, Penninga L et al (2011) Aetiology, treatment and mortality after oesophageal perforation in Denmark. Dan Med Bull 58:A4267PubMed

62.

Schmidt SC, Strauch S, Rösch T et al (2010) Management of esophageal perforation. Surg Endosc 24:2809–2813PubMedCrossRef

63.

Shaker H, Elsayed H, Whittle I et al (2010) The influence of the “golden 24-h rule” on the prognosis of oesophageal perforation in the modern era. Eur J Cardiothorac Surg 38:216–222PubMedCrossRef

64.

Siersema PD, Homs MY, Haringsma J et al (2003) Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus. Gastrointest Endosc 58:356–361PubMedCrossRef

65.

Singh RK, Sahni P, Chattopadhyay TK (2008) Esophageal perforation: the problems of late presentation. Hepatogastroenterology 55:2103–2107PubMed

66.

Sng KK, Koh AJ, Tan NC et al (2008) An Eastern perspective on oesophageal perforation: a high incidence of ingested bones. ANZ J Surg 78:573–578PubMedCrossRef

67.

Sung SW, Park JJ, Kim YT et al (2002) Surgery in thoracic esophageal perforation: primary repair is feasible. Dis Esophagus 15:204–209PubMedCrossRef

68.

Sutcliffe RP, Forshaw MJ, Datta G et al (2009) Surgical management of Boerhaave’s syndrome in a tertiary oesophagogastric centre. Ann R Coll Surg Engl 91:374–380PubMedCrossRef

69.

Terry M, Smith CD, Branum GD et al (2001) Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 15:691–699PubMedCrossRef

70.

Tettey M, Edwin F, Aniteye E et al (2011) Management of intrathoracic oesophageal perforation: analysis of 16 cases. Trop Dr 41:201–203CrossRef

71.

Tomaselli F, Maier A, Pinter H et al (2002) Management of iatrogenous esophagus perforation. Thorac Cardiovasc Surg 50:168–173PubMedCrossRef

72.

Udelnow A, Huber-Lang M, Juchems M et al (2009) How to treat esophageal perforations when determinants and predictors of mortality are considered. World J Surg 33:787–796. doi:10.1007/s00268-008-9857-5 PubMedCrossRef

73.

Vallböhmer D, Hölscher AH, Hölscher M et al (2010) Options in the management of esophageal perforation: analysis of over a 12-year period. Dis Esophagus 23:185–190PubMedCrossRef

74.

Van Heel NC, Haringsma J, Spaander MC et al (2010) Short-term esophageal stenting in the management of benign perforations. Am J Gastroenterol 105:1515–1520PubMedCrossRef

75.

Vanuytsel T, Lerut T, Coosemans W et al (2012) Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol 10:142–149PubMedCrossRef

76.

Vidarsdottir H, Blondal S, Alfredsson H et al (2010) Oesophageal perforations in Iceland: a whole population study on incidence, aetiology and surgical outcome. Thorac Cardiovasc Surg 58:476–480PubMedCrossRef

77.

Vogel SB, Rout WR, Martin TD et al (2005) Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 241:1016–1021PubMedCrossRef

78.

Wang Y, Zhang R, Zhou Y et al (2009) Our experience on management of Boerhaave’s syndrome with late presentation. Dis Esophagus 22:62–67PubMedCrossRef

79.

White RE, Mungatana C, Topazian M (2003) Expandable stents for iatrogenic perforation of esophageal malignancies. J Gastrointest Surg 7:715–720PubMedCrossRef

80.

Zumbro GL, Anstadt MP, Mawulawde K et al (2002) Surgical management of esophageal perforation: role of esophageal conservation in delayed perforation. Am Surg 68:36–40PubMed

81.

Biancari F (2012) On the need of standards for reporting on esophageal perforation. G Chir 33:254–258PubMed

82.

Van Boeckel PGA, Sijbring A, Vlegaar FP et al (2011) Systematic review: temporary stent placement for benign rupture or anastomotic leak of the esophagus. Aliment Pharmacol Ther 33:1292–1301PubMedCrossRef

Titel: Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta-Analysis of 75 Studies
verfasst von: Fausto Biancari
Vito D’Andrea
Rosalba Paone
Carlo Di Marco
Grazia Savino
Vesa Koivukangas
Juha Saarnio
Ersilia Lucenteforte
Publikationsdatum: 01.05.2013
Verlag: Springer-Verlag
Erschienen in: World Journal of Surgery / Ausgabe 5/2013
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-1951-7

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta-Analysis of 75 Studies

Abstract

Background

Methods

Results

Conclusions

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

Darf man die Behandlung eines Neonazis ablehnen?

Deutlich weniger Infektionen: Wundprotektoren schützen!

Chirurginnen und Chirurgen sind stark suizidgefährdet

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2013

Routine Use of Simultaneous Laparoendoscopic Approach in Patients with Confirmed Gallbladder and Bile Duct Stones: Fit for Laparoscopy Fit for “Rendezvous”

Impact of Obesity on Early Surgical and Oncologic Outcomes after Total Gastrectomy with “Over-D1” Lymphadenectomy for Gastric Cancer

Trauma-related Preventable Deaths in Berlin 2010: Need to Change Prehospital Management Strategies and Trauma Management Education

Patterns of Anterior Abdominal Stab Wounds and Their Management at Princess Basma Teaching Hospital, North of Jordan

Laparoscopic Surgical Skills are Significantly Improved by the Use of a Portable Laparoscopic Simulator: Results of a Randomized Controlled Trial

Role of Pre-operative Multiple Gated Acquisition Scanning in Predicting Long-Term Outcome in Patients Undergoing Elective Abdominal Aortic Aneurysm Repair

Update Chirurgie