Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period
Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of...
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| Veröffentlicht in: | Digestive surgery 2020, Vol.37 (4), p.302-311 |
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| creator | Karstens, Karl-Frederick Bellon, Eugen Tachezy, Michael Izbicki, Jakob R. Ghadban, Tarik Duprée, Anna Uzunoglu, Faik G. Bachmann, Kai Koenig, Alexandra Reeh, Matthias |
| description | Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of mortality in a single tertiary center over a 15-year period. Methods: From 2002 to 2017, patients with surgically managed esophageal perforation were identified from our database. Patients with esophageal malignancies were excluded. Etiology, clinical data, treatment, and outcome were analyzed. A multivariate logistic regression analysis was performed to investigate the impact on mortality. Results: A total of 72 patients were identified. The majority of perforations were iatrogenic (54.2%) followed by Boerhaave’s syndrome (23.6%). Most ruptures were found in the distal third of the esophagus (59.7%) measuring |
| doi_str_mv | 10.1159/000504342 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_karge</sourceid><recordid>TN_cdi_karger_primary_504342</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2319501197</sourcerecordid><originalsourceid>FETCH-LOGICAL-c334t-ad9f5827c72c30172773e1fd6a6a37c16bbb23549639253e358533315810ba0b3</originalsourceid><addsrcrecordid>eNpt0M9PwjAUB_DGaBTRg3djlnjRw7Rvb103bwTxRwJighw8LW9bN6djxRZM-O8tATl5atp-3rfpl7Ez4DcAIrnlnAseYhjssQ6EAfhJHOM-6_BAoB_GcXTEjq39dAyjBA7ZEYKUAkTYYc1kaao6p8YbUUuVmql24enSe9GtP6KmrlpyBwOr5x_u1rFXZUptaFHr1t55PW9St1Wj_L6bU8brtdSsbG298Y_bkQfCf1dk1lO1Lk7YQUmNVafbtcumD4O3_pM_HD8-93tDP0cMFz4VSSniQOYyyJGDDKREBWURUUQoc4iyLAtQhEmEifuhQhELRAQRA8-IZ9hlV5vcudHfS2UX6ay2uWoaapVe2jRASAQHSKSj1xuaG22tUWU6N_WMzCoFnq7LTXflOnuxjV1mM1Xs5F-bDlxuwBeZSpkduJ9MNxHpvCidOv9XbV_5BaPUhuA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2319501197</pqid></control><display><type>article</type><title>Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period</title><source>MEDLINE</source><source>Karger Journals</source><creator>Karstens, Karl-Frederick ; Bellon, Eugen ; Tachezy, Michael ; Izbicki, Jakob R. ; Ghadban, Tarik ; Duprée, Anna ; Uzunoglu, Faik G. ; Bachmann, Kai ; Koenig, Alexandra ; Reeh, Matthias</creator><creatorcontrib>Karstens, Karl-Frederick ; Bellon, Eugen ; Tachezy, Michael ; Izbicki, Jakob R. ; Ghadban, Tarik ; Duprée, Anna ; Uzunoglu, Faik G. ; Bachmann, Kai ; Koenig, Alexandra ; Reeh, Matthias</creatorcontrib><description>Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of mortality in a single tertiary center over a 15-year period. Methods: From 2002 to 2017, patients with surgically managed esophageal perforation were identified from our database. Patients with esophageal malignancies were excluded. Etiology, clinical data, treatment, and outcome were analyzed. A multivariate logistic regression analysis was performed to investigate the impact on mortality. Results: A total of 72 patients were identified. The majority of perforations were iatrogenic (54.2%) followed by Boerhaave’s syndrome (23.6%). Most ruptures were found in the distal third of the esophagus (59.7%) measuring <3 cm (61.1%). Patients were treated with exploration and drainage (8.3%), primary suture and patch reinforcement (36.1%), resection and restoration of continuity (25.0%), or resection without restoration of continuity (30.6%). Delayed therapy significantly correlated with sepsis (p < 0.0001) and mortality (p = 0.032). A correlation between an increasing perforation length with sepsis (p = 0.012) was observed. A higher Perforation Severity Score (PSS; OR 4.430; 95% CI 1.143–17.174; p = 0.031) and a higher American Society of Anesthesiologists (ASA) score (OR 2.923; 95% CI 1.011–8.448; p = 0.048) were associated with mortality in multivariate analysis. Conclusion: Esophageal perforations are associated with high mortality, and larger ruptures are associated with worse outcome. Rapid diagnosis and treatment are crucial for patient survival. Hence, PSS and ASA score help to identify high-risk patients. The advantage of surgical management lies in the rapid control of the septic focus in an already critically ill patient. Though, the kind of surgical technique needs to be adjusted to the individual situation.</description><identifier>ISSN: 0253-4886</identifier><identifier>EISSN: 1421-9883</identifier><identifier>DOI: 10.1159/000504342</identifier><identifier>PMID: 31775154</identifier><language>eng</language><publisher>Basel, Switzerland</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Echocardiography, Transesophageal - adverse effects ; Esophageal Perforation - complications ; Esophageal Perforation - etiology ; Esophageal Perforation - mortality ; Esophageal Perforation - pathology ; Esophageal Perforation - surgery ; Esophagus - pathology ; Female ; Gastroscopy - adverse effects ; Humans ; Male ; Mediastinal Diseases - complications ; Middle Aged ; Research Article ; Risk Factors ; Sepsis - etiology ; Severity of Illness Index ; Time-to-Treatment</subject><ispartof>Digestive surgery, 2020, Vol.37 (4), p.302-311</ispartof><rights>2019 S. Karger AG, Basel</rights><rights>2019 S. Karger AG, Basel.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c334t-ad9f5827c72c30172773e1fd6a6a37c16bbb23549639253e358533315810ba0b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,2423,4010,27904,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31775154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karstens, Karl-Frederick</creatorcontrib><creatorcontrib>Bellon, Eugen</creatorcontrib><creatorcontrib>Tachezy, Michael</creatorcontrib><creatorcontrib>Izbicki, Jakob R.</creatorcontrib><creatorcontrib>Ghadban, Tarik</creatorcontrib><creatorcontrib>Duprée, Anna</creatorcontrib><creatorcontrib>Uzunoglu, Faik G.</creatorcontrib><creatorcontrib>Bachmann, Kai</creatorcontrib><creatorcontrib>Koenig, Alexandra</creatorcontrib><creatorcontrib>Reeh, Matthias</creatorcontrib><title>Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period</title><title>Digestive surgery</title><addtitle>Dig Surg</addtitle><description>Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of mortality in a single tertiary center over a 15-year period. Methods: From 2002 to 2017, patients with surgically managed esophageal perforation were identified from our database. Patients with esophageal malignancies were excluded. Etiology, clinical data, treatment, and outcome were analyzed. A multivariate logistic regression analysis was performed to investigate the impact on mortality. Results: A total of 72 patients were identified. The majority of perforations were iatrogenic (54.2%) followed by Boerhaave’s syndrome (23.6%). Most ruptures were found in the distal third of the esophagus (59.7%) measuring <3 cm (61.1%). Patients were treated with exploration and drainage (8.3%), primary suture and patch reinforcement (36.1%), resection and restoration of continuity (25.0%), or resection without restoration of continuity (30.6%). Delayed therapy significantly correlated with sepsis (p < 0.0001) and mortality (p = 0.032). A correlation between an increasing perforation length with sepsis (p = 0.012) was observed. A higher Perforation Severity Score (PSS; OR 4.430; 95% CI 1.143–17.174; p = 0.031) and a higher American Society of Anesthesiologists (ASA) score (OR 2.923; 95% CI 1.011–8.448; p = 0.048) were associated with mortality in multivariate analysis. Conclusion: Esophageal perforations are associated with high mortality, and larger ruptures are associated with worse outcome. Rapid diagnosis and treatment are crucial for patient survival. Hence, PSS and ASA score help to identify high-risk patients. The advantage of surgical management lies in the rapid control of the septic focus in an already critically ill patient. Though, the kind of surgical technique needs to be adjusted to the individual situation.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Echocardiography, Transesophageal - adverse effects</subject><subject>Esophageal Perforation - complications</subject><subject>Esophageal Perforation - etiology</subject><subject>Esophageal Perforation - mortality</subject><subject>Esophageal Perforation - pathology</subject><subject>Esophageal Perforation - surgery</subject><subject>Esophagus - pathology</subject><subject>Female</subject><subject>Gastroscopy - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Mediastinal Diseases - complications</subject><subject>Middle Aged</subject><subject>Research Article</subject><subject>Risk Factors</subject><subject>Sepsis - etiology</subject><subject>Severity of Illness Index</subject><subject>Time-to-Treatment</subject><issn>0253-4886</issn><issn>1421-9883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0M9PwjAUB_DGaBTRg3djlnjRw7Rvb103bwTxRwJighw8LW9bN6djxRZM-O8tATl5atp-3rfpl7Ez4DcAIrnlnAseYhjssQ6EAfhJHOM-6_BAoB_GcXTEjq39dAyjBA7ZEYKUAkTYYc1kaao6p8YbUUuVmql24enSe9GtP6KmrlpyBwOr5x_u1rFXZUptaFHr1t55PW9St1Wj_L6bU8brtdSsbG298Y_bkQfCf1dk1lO1Lk7YQUmNVafbtcumD4O3_pM_HD8-93tDP0cMFz4VSSniQOYyyJGDDKREBWURUUQoc4iyLAtQhEmEifuhQhELRAQRA8-IZ9hlV5vcudHfS2UX6ay2uWoaapVe2jRASAQHSKSj1xuaG22tUWU6N_WMzCoFnq7LTXflOnuxjV1mM1Xs5F-bDlxuwBeZSpkduJ9MNxHpvCidOv9XbV_5BaPUhuA</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Karstens, Karl-Frederick</creator><creator>Bellon, Eugen</creator><creator>Tachezy, Michael</creator><creator>Izbicki, Jakob R.</creator><creator>Ghadban, Tarik</creator><creator>Duprée, Anna</creator><creator>Uzunoglu, Faik G.</creator><creator>Bachmann, Kai</creator><creator>Koenig, Alexandra</creator><creator>Reeh, Matthias</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2020</creationdate><title>Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period</title><author>Karstens, Karl-Frederick ; Bellon, Eugen ; Tachezy, Michael ; Izbicki, Jakob R. ; Ghadban, Tarik ; Duprée, Anna ; Uzunoglu, Faik G. ; Bachmann, Kai ; Koenig, Alexandra ; Reeh, Matthias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c334t-ad9f5827c72c30172773e1fd6a6a37c16bbb23549639253e358533315810ba0b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Echocardiography, Transesophageal - adverse effects</topic><topic>Esophageal Perforation - complications</topic><topic>Esophageal Perforation - etiology</topic><topic>Esophageal Perforation - mortality</topic><topic>Esophageal Perforation - pathology</topic><topic>Esophageal Perforation - surgery</topic><topic>Esophagus - pathology</topic><topic>Female</topic><topic>Gastroscopy - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Mediastinal Diseases - complications</topic><topic>Middle Aged</topic><topic>Research Article</topic><topic>Risk Factors</topic><topic>Sepsis - etiology</topic><topic>Severity of Illness Index</topic><topic>Time-to-Treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karstens, Karl-Frederick</creatorcontrib><creatorcontrib>Bellon, Eugen</creatorcontrib><creatorcontrib>Tachezy, Michael</creatorcontrib><creatorcontrib>Izbicki, Jakob R.</creatorcontrib><creatorcontrib>Ghadban, Tarik</creatorcontrib><creatorcontrib>Duprée, Anna</creatorcontrib><creatorcontrib>Uzunoglu, Faik G.</creatorcontrib><creatorcontrib>Bachmann, Kai</creatorcontrib><creatorcontrib>Koenig, Alexandra</creatorcontrib><creatorcontrib>Reeh, Matthias</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karstens, Karl-Frederick</au><au>Bellon, Eugen</au><au>Tachezy, Michael</au><au>Izbicki, Jakob R.</au><au>Ghadban, Tarik</au><au>Duprée, Anna</au><au>Uzunoglu, Faik G.</au><au>Bachmann, Kai</au><au>Koenig, Alexandra</au><au>Reeh, Matthias</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period</atitle><jtitle>Digestive surgery</jtitle><addtitle>Dig Surg</addtitle><date>2020</date><risdate>2020</risdate><volume>37</volume><issue>4</issue><spage>302</spage><epage>311</epage><pages>302-311</pages><issn>0253-4886</issn><eissn>1421-9883</eissn><abstract>Purpose: Esophageal perforations are associated with high morbidity and mortality. Different nonoperative and operative treatment options have been proposed. This study focuses on the impact of different surgical treatments in nonmalignant esophageal perforations and tries to identify predictors of mortality in a single tertiary center over a 15-year period. Methods: From 2002 to 2017, patients with surgically managed esophageal perforation were identified from our database. Patients with esophageal malignancies were excluded. Etiology, clinical data, treatment, and outcome were analyzed. A multivariate logistic regression analysis was performed to investigate the impact on mortality. Results: A total of 72 patients were identified. The majority of perforations were iatrogenic (54.2%) followed by Boerhaave’s syndrome (23.6%). Most ruptures were found in the distal third of the esophagus (59.7%) measuring <3 cm (61.1%). Patients were treated with exploration and drainage (8.3%), primary suture and patch reinforcement (36.1%), resection and restoration of continuity (25.0%), or resection without restoration of continuity (30.6%). Delayed therapy significantly correlated with sepsis (p < 0.0001) and mortality (p = 0.032). A correlation between an increasing perforation length with sepsis (p = 0.012) was observed. A higher Perforation Severity Score (PSS; OR 4.430; 95% CI 1.143–17.174; p = 0.031) and a higher American Society of Anesthesiologists (ASA) score (OR 2.923; 95% CI 1.011–8.448; p = 0.048) were associated with mortality in multivariate analysis. Conclusion: Esophageal perforations are associated with high mortality, and larger ruptures are associated with worse outcome. Rapid diagnosis and treatment are crucial for patient survival. Hence, PSS and ASA score help to identify high-risk patients. The advantage of surgical management lies in the rapid control of the septic focus in an already critically ill patient. Though, the kind of surgical technique needs to be adjusted to the individual situation.</abstract><cop>Basel, Switzerland</cop><pmid>31775154</pmid><doi>10.1159/000504342</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Echocardiography, Transesophageal - adverse effects Esophageal Perforation - complications Esophageal Perforation - etiology Esophageal Perforation - mortality Esophageal Perforation - pathology Esophageal Perforation - surgery Esophagus - pathology Female Gastroscopy - adverse effects Humans Male Mediastinal Diseases - complications Middle Aged Research Article Risk Factors Sepsis - etiology Severity of Illness Index Time-to-Treatment |
| title | Surgical Management of Non-Malignant Esophageal Perforations: A Single-Center Analysis Over a 15-Year Period |
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