Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy.
BACKGROUND
Esophageal perforation is one of the most dreaded complications in therapeutic gastrointestinal endoscopy. We assessed the frequency of esophageal perforation after endoscopic procedures in a highly specialized endoscopy unit and compared clinical outcomes in patients undergoing either surgical or conservative management.


METHODS
From January 1985 to June 1996, 1011 instrumental endoscopic procedures (dilatation and bougienage) were performed in our department. The computerized complication database was searched to identify all patients with esophageal perforation during this same period, and their records were reviewed.


RESULTS
Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedures. Four perforations resulted from balloon dilatation, and 13 were secondary to bougienage. Six patients were managed surgically (35%), all of them recovering uneventfully. Eleven patients were managed conservatively, mainly because they were unfit for surgery. Survival rate in this group was 82%; only two patients died, both of whom had underlying malignant disease.


CONCLUSIONS
The current concept in management of esophageal perforations comprises surgical as well as medical treatment. In well-selected cases, non-operative treatment can be considered with favorable results.
Adamek
H E
HE
Medical Dept. C, Klinikum Ludwigshafen, Academic Hospital, University of Mainz, Ludwigshafen, Germany.
Jakobs
R
R
Dorlars
D
D
Martin
W R
WR
Krömer
M U
MU
Riemann
J F
JF
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D000900:Anti-Bacterial Agents; D002404:Catheterization / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004724:Endoscopy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D004935:Esophageal Diseases / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D015994:Incidence; D007440:Intubation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents