Instrumental Perforations of the Esophagus

Esophageal perforations occurred in 33 (0.4 percent) of 8,038 patients who underwent peroral gastrointestinal endoscopic procedures at the Mayo Clinic from 1961 through 1967. Esophagoscopy was the procedure most often responsible. Perforations of the cervical portion of the esophagus were more common, but less serious than perforations of the thoraco-abdominal portion. Cervical perforations resulted from technical problems related to the endoscopic procedure or from unfavorable physical characteristics of the patient. Thoraco-abdominal perforations occurred at the site of benign or malignant esophageal strictures and were caused by excessive dilation, dilation without a satisfactory guide, or bougienage or biopsy beyond visual range. The most helpful diagnostic tests were roentgenographic examinations of the neck or thorax, including contrast studies of the esophagus. Results were best when treatment was initiated promptly and pursued aggressively, with use of antibiotics, surgical drainage, and elimination of esophageal obstruction.