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.


Esophageal Cancer Foreign Body Primary Repair Esophageal Perforation Esophageal Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

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


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

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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