Back to Annual Meeting Program

Introduction: Esophageal perforation is rare, but despite improvements in detection, surgical techniques, and intensive care medicine, esophageal perforation remains potentially fatal. For treatment of esophageal perforation, there are several treatment options. Depending on the cause and extent of the perforation the treatment is primary surgical, endoscopic interventional or conservative. The intention for the presented retrospective study is to evaluate the causes and treatment in order to draw conclusions for appropriate therapy for this disease.

Materials and methods: Esophageal perforations treated between 1996 and 2011 were assessed. These were 71 patients (46 men and 25 women) with a median age of 52 years. Clinical data was reviewed and analyzed retrospectively.

Results: Iatrogenic injury was the most frequent cause of esophageal perforation (n = 43, 60%), followed by Boerhaave syndrome (n = 19, 27%) and traumatic perforation caused by accidentally swallowed foreign bodies (n = 7, 10%). In two patients, the reasons were not determinable (3%). The patients were operated in 50.7%, 25 patients (35.2%) were treated endoscopically with stent (n = 23) or endo-VAC (n = 2), 9 patients (12.7%) were treated conservatively with antibiotics and nasogastric tube and one patient (1.4%) with a perforated aortic aneurism into the esophagus died before treatment. Before 2008 operation was performed in 57% (25/44) and after 2008 the proportion of patients who underwent surgery dropped to 41% (11/27), while 50.2% (14/27) received endoscopic management (stent, n = 12 and endo-VAC, n = 2). The hospital mortality was 7% (6.8% before 2008 and 7.4% after 2008).

Conclusion: The evaluation of the individual management of esophageal perforation in a 15 year period shows a trend towards endoscopic treatment, with low mortality.