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Outcome of Patients with Esophageal Perforations: A Multicenter Study

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Recent studies have suggested that stent-grafting may improve the treatment outcome of patients with esophageal perforation, but evidence on this is still lacking.


Data on 194 patients who underwent conservative (43 patients), endoclip (4 patients) stent-grafting (63 patients) or surgical treatment (84 patients) for esophageal perforation were retrieved from nine medical centers.


In-hospital/30-day mortality was 17.5 %. Three-year survival was 67.1 %. Age, coronary artery disease, and esophageal malignancy were independent predictors of early mortality. Chi squared automatic interaction detection analysis showed that patients without coronary artery disease, without esophageal malignancy and younger than 70 years had the lowest early mortality (4.1 %). Surgery was associated with slightly lower early mortality (conservative 23.3, endoclips 25.0 %, stent-grafting 19.0 %, surgery 13.1 %; p = 0.499). One center reported a series of more than 20 patients treated with stent-grafting which achieved an early mortality of 7.7 % (2/26 patients). Stent-grafting was associated with better survival with salvaged esophagus (conservative 76.7 %, endoclips 75.0 %, stent-grafting 77.8 %, surgery 56.0 %; p = 0.019). Propensity score adjusted analysis showed that stent-grafting achieved similar early mortality (p = 0.946), but significantly higher survival with salvaged esophagus than with surgical treatment (p = 0.001, OR 0.253, 95 % CI 0.110–0.585). Primary surgical repair was associated with somewhat lower early mortality (14.6 vs. 19.0 %; p = 0.561) and better survival with salvaged esophagus (85.4 vs. 77.8 %; p = 0.337) than stent-grafting.


Esophageal perforation was associated with a rather high mortality rate in this all-comers population. Stent-grafting failed to decrease operative mortality, but it improved survival with salvaged esophagus. The results of one of the centers indicate that increasing experience with this less invasive procedure may possibly improve the outcome of these patients.

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  1. Barrett NR (1947) Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg 35:216–218

    Article  CAS  PubMed  Google Scholar 

  2. Biancari F, D’Andrea V, Paone R et al (2013) Current treatment and outcomes of esophageal perforations in adults: meta-analysis and meta-regression of 75 studies. World J Surg 37:1051–1059. doi:10.1007/s00268-013-1951-7

    Article  PubMed  Google Scholar 

  3. Søreide JA, Viste A (2011) Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med 19:66

    Article  PubMed Central  PubMed  Google Scholar 

  4. Koivukangas V, Biancari F, Meriläinen S et al (2012) Esophageal stenting for spontaneous esophageal perforation. J Trauma Acute Care Surg 73:1011–1013

    Article  PubMed  Google Scholar 

  5. van Boeckel PG, Sijbring A, Vleggaar FP et al (2011) Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther 33:1292–1301

    Article  PubMed  Google Scholar 

  6. Biancari F (2012) On the need of standards for reporting on esophageal perforation. G Chir 33:254–258

    CAS  PubMed  Google Scholar 

  7. Udelnow A, Huber-Lang M, Juchems M et al (2009) How to treat esophageal perforations when determinants and predictors of mortality are considered. World J Surg 33:787–796. doi:10.1007/s00268-008-9857-5

    Article  PubMed  Google Scholar 

  8. Vidarsdottir H, Blondal S, Alfredsson H et al (2010) Oesophageal perforations in Iceland: a whole population study on incidence, aetiology and surgical outcome. Thorac Cardiovasc Surg 58:476–480

    Article  CAS  PubMed  Google Scholar 

  9. Vogel SB, Rout WR, Martin TD et al (2005) Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 241:1016–1021

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to Fausto Biancari.

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Biancari, F., Saarnio, J., Mennander, A. et al. Outcome of Patients with Esophageal Perforations: A Multicenter Study. World J Surg 38, 902–909 (2014).

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