TY - JOUR
T1 - Esophageal perforation
T2 - Surgical, endoscopic and medical management strategies
AU - Sepesi, Boris
AU - Raymond, Daniel P.
AU - Peters, Jeffrey H.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/7
Y1 - 2010/7
N2 - Purpose of review: The purpose of this article is to review current therapeutic strategies and outcomes in the management of esophageal perforation. The relative rarity and unpredictability of esophageal perforation has precluded a randomized or multiinstitutional study of this condition. Practice standards are based primarily on retrospective reviews and expert opinions. Recent findings: The last decade has observed a shift from an aggressive early operative intervention to a judicious, nonoperative management of esophageal perforation in selected patients. Encouraging outcomes for nonoperative management published in recent literature result from advancements in esophageal stent technology, imaging sciences, and critical care. Summary: Perforation of the esophagus, regardless of the cause, remains a major life-threatening event. Early recognition and aggressive care by a clinical team with experience in a variety of treatment modalities is increasingly important in achieving optimal outcomes in this difficult problem. Recently, encouraging results have been published utilizing esophageal stents and diligent nonoperative care in patients with esophageal perforation. The guiding principles in the treatment of this challenging condition remain early diagnosis, appropriate resuscitation, sepsis control, nutritional support, and re-establishment of esophageal continuity. Herein, we review the recent reports on the surgical, medical, and endoscopic treatment of esophageal perforation.
AB - Purpose of review: The purpose of this article is to review current therapeutic strategies and outcomes in the management of esophageal perforation. The relative rarity and unpredictability of esophageal perforation has precluded a randomized or multiinstitutional study of this condition. Practice standards are based primarily on retrospective reviews and expert opinions. Recent findings: The last decade has observed a shift from an aggressive early operative intervention to a judicious, nonoperative management of esophageal perforation in selected patients. Encouraging outcomes for nonoperative management published in recent literature result from advancements in esophageal stent technology, imaging sciences, and critical care. Summary: Perforation of the esophagus, regardless of the cause, remains a major life-threatening event. Early recognition and aggressive care by a clinical team with experience in a variety of treatment modalities is increasingly important in achieving optimal outcomes in this difficult problem. Recently, encouraging results have been published utilizing esophageal stents and diligent nonoperative care in patients with esophageal perforation. The guiding principles in the treatment of this challenging condition remain early diagnosis, appropriate resuscitation, sepsis control, nutritional support, and re-establishment of esophageal continuity. Herein, we review the recent reports on the surgical, medical, and endoscopic treatment of esophageal perforation.
KW - Esophagus
KW - Outcomes
KW - Perforation
KW - Stents
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U2 - 10.1097/MOG.0b013e32833ae2d7
DO - 10.1097/MOG.0b013e32833ae2d7
M3 - Review article
C2 - 20473156
AN - SCOPUS:77954142027
SN - 0267-1379
VL - 26
SP - 379
EP - 383
JO - Current opinion in gastroenterology
JF - Current opinion in gastroenterology
IS - 4
ER -