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A national survey on esophageal perforation: study of cases at accredited institutions by the Japanese Esophagus Society

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Abstract

Objective

To get a clear view of the current state of treatment for esophageal perforation in Japan.

Summary background data

Esophagus perforations are the most serious gastrointestinal tract perforations and are associated with high morbidity and mortality. The optimal treatment choice remains unknown.

Methods

We conducted a retrospective clinical review of 182 esophageal perforation cases at 108 hospitals accredited by the Japanese Esophageal Society between January 2010 and December 2015.

Results

We found that 20.9% of patients were incorrectly diagnosed initially. We observed mediastinum emphysema in 83.5% of patients, and serious abscess formations of the mediastinum and intrathoracic cavity in 38.6% and 29.6%, respectively. The lower esophagus was the most commonly perforated site (77.7%). Management of esophageal perforations included nonoperative treatment in 20 patients (11%) and operative treatment in 162 patients (89%). The overall mortality rate was 6.9%. The survivors had significantly shorter times from symptom appearance to visit (p = 0.0016), and from time to visit to diagnosis confirmation (p = 0.0011). Moreover, patients older than 65 years, white blood cells less than 3000/mm3, C-reactive protein > 10 mg/L, or abscesses in the thoracic cavity showed significantly higher mortality than others.

Conclusion

Shortening the time from onset to the start of treatment contributes to reduce mortality in patients with esophageal perforation. Moreover, strict medical treatment is necessary to lower the mortality rate of elderly patients with strong inflammation and abscesses in the thoracic cavity.

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Acknowledgements

Table 5 Facilities cooperated in the questionnaire of this research
Full size table

Table 5 lists the facilities that cooperated in answering the questionnaires for this research. We are grateful for their help. In addition, we would like to thank Professor Ken Shirabe for his effort in producing this paper.

Author information

Authors and Affiliations

  1. Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Makoto Sohda, Hiroyuki Kuwano, Makoto Sakai & Tatsuya Miyazaki

  2. Division of Gastro-Intestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Yoshihiro Kakeji

  3. Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan

    Yasushi Toh

  4. Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Hisahiro Matsubara

Authors
  1. Makoto Sohda
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  2. Hiroyuki Kuwano
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  3. Makoto Sakai
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  4. Tatsuya Miyazaki
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  5. Yoshihiro Kakeji
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  6. Yasushi Toh
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  7. Hisahiro Matsubara
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Corresponding author

Correspondence to Makoto Sohda.

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Ethical Statement

The Ethics Committee of each institution approved our retrospective analysis.

Conflict of interest

The authors have no financial conflicts of interest to disclose concerning the study.

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Electronic supplementary material

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10388_2020_744_MOESM1_ESM.pptx

Supplemental Figure 1: The median times for each period are 4.5 hours from symptom appearance to visit, 1 hour from visit to diagnosis confirmation, and 2 hours from diagnosis confirmation to decision of treatment strategy. Supplemental Figure 2: a: In iatrogenic and idiopathic cases, there was a significant choice of nonoperative treatment (p=0.003). b: Cases without involvement of thoracic cavity were significantly treated by nonoperative approaches (p=0.002). c: Cases without thoracic drain insertions were significantly treated by nonoperative approaches (p=0.001). Supplemental Figure 3: a: Surgical conversion group had significantly lower CRP levels than those who completed the nonoperative treatment. b: Surgical conversion rate was significantly higher in cases where emesis and trauma were the onset factors and that it was lower in iatrogenic perforation cases. Supplemental Figure 4: The most frequent operative treatment cases were caused by emesis, followed by iatrogenic, and idiopathic perforations. (PPTX 69 kb)

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Sohda, M., Kuwano, H., Sakai, M. et al. A national survey on esophageal perforation: study of cases at accredited institutions by the Japanese Esophagus Society. Esophagus 17, 230–238 (2020). https://doi.org/10.1007/s10388-020-00744-7

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  • DOI: https://doi.org/10.1007/s10388-020-00744-7

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