title: Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies.
abstract: BACKGROUND
  The current prognosis of esophageal perforation and the efficacy of available treatment methods are not well defined.
  
  
  METHODS
  We performed a systematic review of esophageal perforations published from January 2000 to April 2012 and subjected a proportion of the retrieved data to a meta-analysis. Meta-regression was performed to determine predictors of mortality immediately after esophageal perforation.
  
  
  RESULTS
  Analysis of 75 studies resulted in a pooled mortality of 11.9 % [95 % confidence interval (CI) 9.7-14.3: 75 studies with 2,971 patients] with a mean hospital stay of 32.9 days (95 % CI 16.9-48.9: 28 studies with 1,233 patients). Cervical perforations had a pooled mortality of 5.9 %, thoracic perforations 10.9 %, and intraabdominal perforations 13.2 %. Mortality after esophageal perforation secondary to foreign bodies was 2.1 %, iatrogenic perforation 13.2 %, and spontaneous perforation 14.8 %. Treatment started within 24 h after the event resulted in a mortality rate of 7.4 % compared with 20.3 % in patients treated later (risk ratio 2.279, 95 % CI 1.632-3.182). Primary repair was associated with a pooled mortality of 9.5 %, esophagectomy 13.8 %, T-tube or any other tube repair 20.0 %, and stent-grafting 7.3 %.
  
  
  CONCLUSIONS
  Results of recent studies indicate that mortality after esophageal perforation is high despite any definitive surgical or conservative strategy. Stent-grafting is associated with somewhat lower mortality rates, but studies may be biased by patient selection and limited experience.
authors: Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029 Oulu, Finland. faustobiancari@yahoo.it
authors: Fausto
authors: F
authors: Biancari
authors: Vito
authors: V
authors: D'Andrea
authors: Rosalba
authors: R
authors: Paone
authors: Carlo
authors: C
authors: Di Marco
authors: Grazia
authors: G
authors: Savino
authors: Vesa
authors: V
authors: Koivukangas
authors: Juha
authors: J
authors: Saarnio
authors: Ersilia
authors: E
authors: Lucenteforte
mesh_terms: D000328:Adult; D004322:Drainage; D004939:Esophageal Perforation / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy; D004945:Esophagoscopy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D015233:Models, Statistical; D015607:Stents; D016896:Treatment Outcome