Perforated esophageal intervention focus (PERF) study: a multi-center examination of contemporary treatment
| Autor: | J. D. Spicer, Chad G. Ball, Elizabeth A. David, David Skarupa, J. T. Ali, Anthony L. Estrera, Stefano Siboni, Gary Vercruysse, Xian Luo-Owen, Luigi Bonavina, Charles C. Miller, J. Bini, Joseph J. DuBose, R. D. Rice, Thomas O'Callaghan, Kamal G. Khalil, Sebron Harrison |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Canada Boerhaave syndrome Perforation (oil well) 03 medical and health sciences 0302 clinical medicine Postoperative Complications Esophageal stent medicine Risk of mortality Humans Esophagus Aged Retrospective Studies Esophageal Perforation medicine.diagnostic_test business.industry Gastroenterology General Medicine Middle Aged medicine.disease United States Endoscopy Surgery Europe medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Etiology 030211 gastroenterology & hepatology Female Stents Esophagoscopy business Penetrating trauma |
| Zdroj: | Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus. 30(11) |
| ISSN: | 1442-2050 |
| Popis: | The treatment of esophageal perforation (EP) remains a significant clinical challenge. While a number of investigators have previously documented efficient approaches, these were mostly single-center experiences reported prior to the introduction of newer technologies: specifically endoluminal stents. This study was designed to document contemporary practice in the diagnosis and management of EP at multiple institutions around the world and includes early clinical outcomes. A five-year (2009-2013) multicenter retrospective review of management and outcomes for patients with thoracic or abdominal esophageal perforation was conducted. Demographics, etiology, diagnostic modalities, treatments, subsequent early outcomes as well as morbidity and mortality were captured and analyzed. During the study period, 199 patients from 10 centers in the United States, Canada, and Europe were identified. Mechanisms of perforation included Boerhaave syndrome (60, 30.1%), iatrogenic injury (65, 32.6%), and penetrating trauma (25, 12.6%). Perforation was isolated to the thoracic segment alone in 124 (62.3%), with 62 (31.2%) involving the thoracoabdominal esophagus. Mean perforation length was 2.5 cm. Observation was selected as initial management in 65 (32.7%), with only two failures. Direct operative intervention was initial management in 65 patients (32.6%), while 29 (14.6%) underwent esophageal stent coverage. Compared to operative intervention, esophageal stent patients were significantly more likely to be older (61.3 vs. 48.3 years old, P < 0.001) and have sustained iatrogenic mechanisms of esophageal perforation (48.3% vs.15.4%). Secondary intervention requirement for patients with perforation was 33.7% overall (66). Complications included sepsis (56, 28.1%), pneumonia (34, 17.1%) and multi-organ failure (23, 11.6%). Overall mortality was 15.1% (30). In contemporary practice, diagnostic and management approaches to esophageal perforation vary widely. Despite the introduction of endoluminal strategies, it continues to carry a high risk of mortality, morbidity, and need for secondary intervention. A concerted multi-institutional, prospectively collected database is ideal for further investigation. |
| Databáze: | OpenAIRE |
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