Development of a Multidisciplinary Program to Expedite Care of Esophageal Emergencies

Ceppa, DuyKhanh P.; Rosati, Carlo; Chabtini, Lola; Stokes, Samantha; Cook, Holly; Rieger, Karen M.; Birdas, Thomas J.; Lappas, John C.; Kessler, William R.; DeWitt, John M.; Maglinte, Dean D. T.; Kesler, Kenneth A.

doi:10.1016/j.athoracsur.2017.03.023

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…Our recommendation for obtaining an esophagram prior to transfer when able is supported by previous studies. Ceppa et al ( 10 ) reviewed patients transferred to their institution with suspected esophageal perforation. The authors found that a proportion (46%, n=33/71) of patients transferred due to pneumomediastinum were subsequently found to have no esophageal perforation on esophagram.…”

Section: Discussionmentioning

confidence: 99%

Esophagram should be performed to diagnose esophageal perforation before inter-hospital transfer

Madsen¹,

Stuart²,

Wojcik³

et al. 2023

J Thorac Dis

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Background: Early recognition of esophageal perforation may prevent morbidity and mortality, and accurate diagnostic imaging facilitates triage. Stable patients with suspected perforation may be transferred to higher levels of care before appropriate work-up and diagnosis confirmation. We reviewed patients transferred for esophageal perforation to critically analyze the diagnostic workflow.Methods: We performed a retrospective review of patients transferred to our tertiary care institution from 2015-2021 for suspected esophageal perforation. Demographics, referring site characteristics, diagnostic studies, and management were analyzed. Bivariate comparisons were performed using Wilcoxon-Mann-Whitney tests for continuous variables and chi-squared or Fisher's exact tests for categorical variables.Results: Sixty-five patients were included. Etiology of suspected perforation was spontaneous in 53.8% and iatrogenic in 33.8%. Most patients were transferred within 24 hours from time of suspected perforation (66.2%). Transferring sites included seven states and were 101-300 miles (32.3%) or >300 miles (26.2%) away. CT imaging was obtained in 96.9% before transfer, most commonly demonstrating pneumomediastinum (46.2%). Only 21.5% of patients had an esophagram before transfer. Following transfer, 36.9% (n=24) were ultimately not found to have esophageal perforation, demonstrated by negative arrival esophagram in 79.1%. In patients with confirmed perforation (n=41), 58.5% had surgery, 26.8% endoscopic intervention, and 14.6% supportive care.Conclusions: After transfer a proportion of patients were ultimately found to not have esophageal perforation, typically demonstrated by negative esophagram upon arrival. We conclude that a recommendation of performing esophagram at the presenting site, when possible, may prevent unnecessary transfers, and will likely reduce costs, conserve resources, and decrease management delays.

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Section: Discussionmentioning

confidence: 99%

Esophagram should be performed to diagnose esophageal perforation before inter-hospital transfer

Madsen¹,

Stuart²,

Wojcik³

et al. 2023

J Thorac Dis

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Minimally invasive surgical management of spontaneous esophageal perforation (Boerhaave’s syndrome)

et al. 2019

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Surgical Management of Esophageal Perforation: Examining Trends in a Multi-Institutional Cohort

Wong

Leipzig

Liou

et al. 2023

Journal of Gastrointestinal Surgery

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Development of a Multidisciplinary Program to Expedite Care of Esophageal Emergencies

Abstract: Development of an esophageal emergency referral program has facilitated multidisciplinary care at a high-volume institution, and early outcomes appear favorable.

Cited by 4 publications

References 17 publications

Esophagram should be performed to diagnose esophageal perforation before inter-hospital transfer

Esophagram should be performed to diagnose esophageal perforation before inter-hospital transfer

Minimally invasive surgical management of spontaneous esophageal perforation (Boerhaave’s syndrome)

Surgical Management of Esophageal Perforation: Examining Trends in a Multi-Institutional Cohort

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