COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC ESOPHAGEAL PERFORATIONS
Omar Siad Nur, H., Mahfouz M. Omar, M., Mahmoud El Hefny, A., Alsayed Hamed, M., el-din Abdalla Ali., A. (2022). COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC ESOPHAGEAL PERFORATIONS. EKB Journal Management System, 73(3), 613-624. doi: 10.21608/asmj.2022.270237
Hassan Omar Siad Nur; Mohamed Mahfouz M. Omar; Amr Mohamed Mahmoud El Hefny; Mohammed Abdalmageed Alsayed Hamed; Ayman Hussam el-din Abdalla Ali.. "COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC ESOPHAGEAL PERFORATIONS". EKB Journal Management System, 73, 3, 2022, 613-624. doi: 10.21608/asmj.2022.270237
Omar Siad Nur, H., Mahfouz M. Omar, M., Mahmoud El Hefny, A., Alsayed Hamed, M., el-din Abdalla Ali., A. (2022). 'COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC ESOPHAGEAL PERFORATIONS', EKB Journal Management System, 73(3), pp. 613-624. doi: 10.21608/asmj.2022.270237
Omar Siad Nur, H., Mahfouz M. Omar, M., Mahmoud El Hefny, A., Alsayed Hamed, M., el-din Abdalla Ali., A. COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC ESOPHAGEAL PERFORATIONS. EKB Journal Management System, 2022; 73(3): 613-624. doi: 10.21608/asmj.2022.270237

COMPARATIVE STUDY BETWEEN DIFFERENT MANAGEMENT MODALITIES OF IATROGENIC ESOPHAGEAL PERFORATIONS

Ain Shams Medical Journal
Article 14, Volume 73, Issue 3, September 2022, Page 613-624  XML PDF (434.67 K)
Document Type: Original Article
DOI: 10.21608/asmj.2022.270237
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Authors
Hassan Omar Siad Nur1; Mohamed Mahfouz M. Omar1; Amr Mohamed Mahmoud El Hefny1; Mohammed Abdalmageed Alsayed Hamed1; Ayman Hussam el-din Abdalla Ali.2
1General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Abstract
Background: Iatrogenic esophageal perforation accounts 60% of esophageal perforations and associated with 19% of mortality. Endoscopic procedures & invasive surgical maneuvers are the common causes. Pain, dysphagia and subcutaneous emphysema are common manifestations. Water soluble contrast study, CT scan, and endoscopy provide a high sensitivity for diagnosis. Early aggressive management within the first 24 hours is crucial for excellent outcomes; majority of patients is suitable for non-operative management while surgical intervention and esophageal stenting are alternative treatment options.
Aim of the work: To compare efficacy of different management modalities in patients with iatrogenic esophageal perforations.
Patient and Methods: Papers provided data from March 2007 to June 2022 related to patients with iatrogenic esophageal perforation & comparing different management modalities are reviewed between January 2021 and June 2022. We made pairwise meta-analyses of our outcomes using Comprehensive Meta-Analysis software (CMA version 3.9). Event rate with the corresponding 95% confidence intervals (95%CI) was also being calculated for categorical data.
Results: In majority of patients non-operative management is the best option with successful rate of more than 90% and lowest mortality (6.3%). Surgical management is warranted in the patients who do not meet the criteria for conservative treatment with successful rate of more than 80%. Esophageal stent is an alternative treatment option with 50 to 83% of esophageal healing.
Conclusions: The treatment method still has to be chosen on an individual basis. We recommend conservative treatment when indicated. Extended perforations should be treated with a surgical approach and esophageal stenting have a satisfactory outcome in suitable patients.

Keywords
esophagus; iatrogenic; perforation; management; conservative; stent. Meta-analysis
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