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Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta-Analysis of 75 Studies

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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.

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Conflict of interest

The authors stated that do not have any conflict of interest related with this study.

Funding

The authors state that this study was performed without any financial support.

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Authors and Affiliations

  1. Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland

    Fausto Biancari, Rosalba Paone, Vesa Koivukangas & Juha Saarnio

  2. Department of Surgical Sciences, University of Rome “La Sapienza”, Rome, Italy

    Vito D’Andrea, Carlo Di Marco & Grazia Savino

  3. Department of Preclinical and Clinical Pharmacology “M. Aiazzi Mancini”, University of Florence, Florence, Italy

    Ersilia Lucenteforte

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  1. Fausto Biancari
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  2. Vito D’Andrea
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  4. Carlo Di Marco
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  5. Grazia Savino
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  6. Vesa Koivukangas
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Correspondence to Fausto Biancari.

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Biancari, F., D’Andrea, V., Paone, R. et al. Current Treatment and Outcome of Esophageal Perforations in Adults: Systematic Review and Meta-Analysis of 75 Studies. World J Surg 37, 1051–1059 (2013). https://doi.org/10.1007/s00268-013-1951-7

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