title: Esophageal perforation: surgical, endoscopic and medical management strategies.
abstract: OBJECTIVE
  The purpose of this article is to review current therapeutic strategies and outcomes in the management of esophageal perforation. The relative rarity and unpredictability of esophageal perforation has precluded a randomized or multiinstitutional study of this condition. Practice standards are based primarily on retrospective reviews and expert opinions.
  
  
  RESULTS
  The last decade has observed a shift from an aggressive early operative intervention to a judicious, nonoperative management of esophageal perforation in selected patients. Encouraging outcomes for nonoperative management published in recent literature result from advancements in esophageal stent technology, imaging sciences, and critical care.
  
  
  CONCLUSIONS
  Perforation of the esophagus, regardless of the cause, remains a major life-threatening event. Early recognition and aggressive care by a clinical team with experience in a variety of treatment modalities is increasingly important in achieving optimal outcomes in this difficult problem. Recently, encouraging results have been published utilizing esophageal stents and diligent nonoperative care in patients with esophageal perforation. The guiding principles in the treatment of this challenging condition remain early diagnosis, appropriate resuscitation, sepsis control, nutritional support, and re-establishment of esophageal continuity. Herein, we review the recent reports on the surgical, medical, and endoscopic treatment of esophageal perforation.
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Sepesi
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Raymond
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Peters
mesh_terms: D003131:Combined Modality Therapy; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality; D015607:Stents