World Journal of Surgery

, Volume 37, Issue 5, pp 1051–1059 | Cite as

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

  • Fausto Biancari
  • Vito D’Andrea
  • Rosalba Paone
  • Carlo Di Marco
  • Grazia Savino
  • Vesa Koivukangas
  • Juha Saarnio
  • Ersilia Lucenteforte



The current prognosis of esophageal perforation and the efficacy of available treatment methods are not well defined.


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.


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 %.


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.

Supplementary material

268_2013_1951_MOESM1_ESM.rtf (144 kb)
Supplementary material 1 (RTF 144 kb)


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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Fausto Biancari
    • 1
  • Vito D’Andrea
    • 2
  • Rosalba Paone
    • 1
  • Carlo Di Marco
    • 2
  • Grazia Savino
    • 2
  • Vesa Koivukangas
    • 1
  • Juha Saarnio
    • 1
  • Ersilia Lucenteforte
    • 3
  1. 1.Department of SurgeryOulu University HospitalOuluFinland
  2. 2.Department of Surgical SciencesUniversity of Rome “La Sapienza”RomeItaly
  3. 3.Department of Preclinical and Clinical Pharmacology “M. Aiazzi Mancini”University of FlorenceFlorenceItaly

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