Schizas Dimitrios, Theochari Nikoletta A, Mylonas Konstantinos S, Kanavidis Prodromos, Spartalis Eleftherios, Triantafyllou Stamatina, Economopoulos Konstantinos P, Theodorou Dimitrios, Liakakos Theodore
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece.
Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece.
World J Gastrointest Surg. 2020 Mar 27;12(3):104-115. doi: 10.4240/wjgs.v12.i3.104.
Acute esophageal necrosis (AEN) is a rare entity with multifactorial etiology, usually presenting with signs of upper gastrointestinal bleeding.
To systematically review all available data on demographics, clinical features, outcomes and management of this medical condition.
A systematic literature search was performed with respect to the PRISMA statement (end-of-search date: October 24, 2018). Data on the study design, interventions, participants and outcomes were extracted by two independent reviewers.
Seventy-nine studies were included in this review. Overall, 114 patients with AEN were identified, of whom 83 were males and 31 females. Mean patient age was 62.1 ± 16.1. The most common presenting symptoms were melena, hematemesis or other manifestations of gastric bleeding (85%). The lower esophagus was most commonly involved (92.9%). The most widely implemented treatment modality was conservative treatment (75.4%), while surgical or endoscopic intervention was required in 24.6% of the cases. Mean overall follow-up was 66.2 ± 101.8 d. Overall 29.9% of patients died either during the initial hospital stay or during the follow-up period. Gastrointestinal symptoms on presentation [Odds ratio 3.50 (1.09-11.30), = 0.03] and need for surgical or endoscopic treatment [surgical: Odds ratio 1.25 (1.03-1.51), = 0.02; endoscopic: Odds ratio 1.4 (1.17-1.66), < 0.01] were associated with increased odds of complications. A sub-analysis separating early versus late cases (after 2006) revealed a significantly increased frequency of surgical or endoscopic intervention (9.7 % 30.1% respectively, = 0.04).
AEN is a rare condition with controversial pathogenesis and unclear optimal management. Although the frequency of surgical and endoscopic intervention has increased in recent years, outcomes have remained the same. Therefore, further research work is needed to better understand how to best treat this potentially lethal disease.
急性食管坏死（AEN）是一种病因多因素的罕见疾病，通常表现为上消化道出血症状。
系统回顾有关该疾病的人口统计学、临床特征、预后及治疗的所有可用数据。
按照PRISMA声明进行系统文献检索（检索截止日期：2018年10月24日）。两名独立评审员提取关于研究设计、干预措施、参与者及预后的数据。
本综述纳入79项研究。共识别出114例AEN患者，其中男性83例，女性31例。患者平均年龄为62.1±16.1岁。最常见的症状为黑便、呕血或其他胃出血表现（85%）。食管下段最常受累（92.9%）。应用最广泛的治疗方式为保守治疗（75.4%），而24.6%的病例需要手术或内镜干预。平均总随访时间为66.2±101.8天。总体而言，29.9%的患者在初次住院期间或随访期间死亡。出现胃肠道症状[比值比3.50（1.09 - 11.30），P = 0.03]以及需要手术或内镜治疗[手术：比值比1.25（1.03 - 1.51），P = 0.02；内镜：比值比1.4（1.17 - 1.66）,P < 0.01]与并发症发生几率增加相关。一项将早期与晚期病例（2006年后）分开进行的亚分析显示，手术或内镜干预的频率显著增加（分别为9.7%和30.1%，P = 0.04）。
AEN是一种发病机制存在争议且最佳治疗方案尚不明确的罕见疾病。尽管近年来手术和内镜干预的频率有所增加，但预后仍未改变。因此，需要进一步开展研究工作以更好地了解如何最佳治疗这种潜在致命性疾病。
