Outcome of Patients with Esophageal Perforations: A Multicenter Study

Biancari, Fausto; Saarnio, Juha; Mennander, Ari; Hypèn, L.; Salminen, Paulina; Kuttila, Kari; Victorzon, Mikael; Böckelman, Camilla; Tarantino, Enrico; Tiffet, Olivier; Koivukangas, Vesa; Søreide, Jon Arne; Viste, Asgaut; Bonavina, Luigi; Viðarsdóttir, Halla; Guðbjartsson, Tómas

doi:10.1007/s00268-013-2312-2

Cited by 56 publications

(36 citation statements)

References 13 publications

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“…Markar et al in a large 12-year retrospective multicenter study of 2564 patients demonstrated a significant reduction in the overall number of surgical procedures with a concomitant increase in non-operative management [17]. Minimally invasive endoscopic stenting or clipping for iatrogenic perforation has also been proposed for small discontinuities with viable, non-necrotic edges [18, 19]. These strategies may be useful in selected, hemodynamically stable trauma patients with a contained leak [20].…”

Section: Discussionmentioning

confidence: 99%

Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank

et al. 2017

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BackgroundTraumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality.MethodsThis National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications.ResultsA total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV–V), hypotension on admission, and GCS <9 as independent risk factors associated with increased mortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148–0.546; p < 0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06–2.53; p = 0.026).ConclusionsDespite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with improved survival.Trial registrationiStar, HS-16-00883

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Section: Discussionmentioning

confidence: 99%

Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank

et al. 2017

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“…The patients in the current study were also either poor candidates or had already failed such methods. E-Vac therapy compares favorably (no 30-day mortality) to the mortality rates associated with stent placement (7.3-19 %) and surgical repair (9.5-13.1 %) for esophageal perforations [4,16]. E-Vac therapy averaged 5 weeks (35.8 days) compared to 6-8 weeks for stent placement and a recovery period of almost 5 weeks (33 days) with surgical therapy [4,7].…”

Section: Discussionmentioning

confidence: 99%

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

et al. 2015

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“…In general a specialist multidisciplinary approach, considering the patients' condition on one hand and the particular characteristics and dynamics of the oesophageal perforation on the other hand, is the key to an optimal treatment [215,[218][219][220][221][222][223].…”

Section: Diagnosismentioning

confidence: 99%

“…Over time a clear treatment shift towards less invasive treatment options can be observed [52,215,[217][218][219][220][221][222][223].…”

Section: Diagnosismentioning

confidence: 99%

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Abu‐Omar

Kocher

Bosco

et al. 2017

Eur J Cardiothorac Surg

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Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.

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Outcome of Patients with Esophageal Perforations: A Multicenter Study

Cited by 56 publications

References 13 publications

Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank

Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank

The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

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