Upper gastrointestinal perforation

Abstract

Perforations of the upper gastrointestinal tract are rare events but if present, are serious conditions. Timely diagnosis and therapeutic initiation are crucial for a beneficial patient outcome. In general, endoscopic and surgical approaches are suitable methods. Endoscopically, there are multiple methodologies available dependent on the extent of the laceration and ongoingly, more innovative techniques are being introduced. Smaller and acute lesions without significant amounts of contamination can be sufficiently treated with clipping devices. Larger defects can be treated by either endoscopic stenting or the more innovative approach of endoscopic vacuum therapy. The surgical approach is usually the option of last resort. Morbidity and mortality rates postoperatively are high, hence the indication for a surgical revision of upper gastrointestinal perforations must be strict and well weighted. In sum, to guarantee the most optimal outcome for the patient, it is crucial to pursue an interdisciplinary approach involving specialists from endoscopy, intensive care medicine, and surgery.