A regional audit of iatrogenic perforation of tumours of the oesophagus and cardia

Abstract

Summary Introduction : With the rising incidence of oesophageal cancer, palliative treatment has an increasingly important role. With median survival unlikely to exceed 6 months, in advanced disease the palliative therapy chosen must not hasten patient's demise. Aim : To establish the outcome of both modern and historical palliative treatment in oesophageal tumours, with emphasis on the aetiology and outcome of iatrogenic perforation. Methods : Patients with oesophageal or cardia carcinoma treated within the West Midlands between 1992 and 1996 were identified retrospectively. Information was gathered from hospital case notes and the regional cancer intelligence unit with hospitals visited to capture data. All episodes were entered into a dedicated database. Results : Of the 3660 patients who were treated, 2529 received palliation as primary treatment, with 5259 palliative procedures performed; 164 iatrogenic perforations were recorded; 83 were due to diagnostic endoscopy (endoscopic perforation) with the reminder due to interventional palliative procedures. Median survival from all forms of palliation was 138 days. Following perforation survival was 95 days after interventional palliative procedure and 58 days after endoscopic perforation (P > 0.05). Thirty‐day mortality after emergency surgery was 11.8% with mean survival of 7.5 months. Conclusion : Perforation at diagnostic endoscopy is associated with substantial mortality despite rapid intervention. Patients with suspected cancer must be investigated with extreme care to reduce iatrogenic complications.

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

“…The disease is often inoperable and in these circumstances treatment is palliative. 19,20 Non-operative treatment, such as insertion of a metallic covered stent, is the usual practice at our centre. Stenting of the intrathoracic portion of the oesophagus is technically straightforward and is successful in most cases.…”

Endoscopic Dilation of Benign and Malignant Esophageal Strictures

“…The perforation rate for esophageal strictures after dilation has been reported to be 0.1-1% [11]. A United Kingdom regional audit reported an overall perforation rate of 2.6% with a mortality of 1% [32]. In that study, perforation was less common following dilatation of benign strictures (1.1%) than following dilatation of malignant strictures (6.4%) [31].…”

“…In older studies, perforation was most commonly associated with the blind passage of Maloney or non-wireguided bougies into complex strictures [10,31]. In another study from England the incidence of iatrogenic perforation for endoscopic treatment of tumors of the esophagus and cardia was 3.3% [32]. A common practice in England at that time was the use of single-sized bougies.…”

“…Esophageal perforation is the major complication associated with endoscopic dilation [4,[29][30][31][32]. The perforation rate for esophageal strictures after dilation has been reported to be 0.1-1% [11].…”

Palliative cardia resection with gastroesophageal reconstruction for perforated carcinoma of the gastroesophageal junction

“…The difference in survival between the resected and non-resected group of patients was not significant. Similarly, Jethwa et al [6] have analyzed 83 iatrogenic perforations during diagnostic endoscopy, of which, 27 were managed by surgery. The median survival in the whole cohort was 72 d. There was a trend for longer survival in patients undergoing surgery.…”