Treatment of endoscopic esophageal perforation.
BACKGROUND
The increasing usage of flexible endoscopy leads to a higher incidence of esophageal perforations, whose treatment strategies (conservative or operative) still are discussed controversially. We present our experiences and therapy concepts in relation to 75 iatrogenic esophageal perforations.


METHODS
Between 1983 and 1997, 75 patients were treated for endoscopic perforation of the esophagus. The gender distribution was 31 females (41.3%) and 44 males (58.7%), with a mean age of 64.4 years (range 2-90 years).


RESULTS
Therapeutic endoscopy was the most common cause of perforation (73 of 75 patients; 97.3%). Diagnostic endoscopy caused perforation in 2 patients (2.7%). The perforation was located in the cervical part of the esophagus in 7 patients (9.3%), the intrathoracic part in 25 patients (33.3%), and the abdominal part in 43 patients (57.3%). In this study population, 25 patients (33.3%) were treated surgically, and 50 patients (66.7%) conservatively. The overall in-hospital mortality rate was 14 of 75 patients (18.7%). In the surgically treated group the rate was 6 of 25 patients (24%) and in the conservative group 8 of 50 patients (16%).


CONCLUSIONS
The decision of a treatment strategy depends on different factors such as the location and extent of the injury, the time interval between perforation and treatment onset, the preexisting diseases, and the patient's general condition. In view of these factors, an individual therapy concept should be determined for every patient.
Fernandez
F F
FF
Department of Surgery, University Hospital Mannheim, University of Heidelberg Medical School, Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer, 68167 Mannheim, Germany.
Richter
A
A
Freudenberg
S
S
Wendl
K
K
Manegold
B C
BC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D014014:Tissue Adhesives / Q000627:therapeutic use
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives