Colón Anthony Robateau, Kamboj Amrit K, Hagen Catherine E, Rattan Puru, Coelho-Prabhu Nayantara, Buttar Navtej S, Bruining David H, Storm Andrew C, Larson Mark V, Viggiano Thomas R, Wong Kee Song Louis M, Wang Kenneth K, Iyer Prasad G, Katzka David A, Leggett Cadman L
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2022 Oct;97(10):1849-1860. doi: 10.1016/j.mayocp.2022.03.018. Epub 2022 Jun 30.
To describe the clinical, endoscopic, and histologic features in patients with acute esophageal necrosis (AEN).
In this retrospective cohort study, patients who were diagnosed as having AEN at Mayo Clinic sites in Minnesota, Florida, and Arizona between January 1, 1996, and January 31, 2021, were included. Data were collected on patient clinical characteristics and endoscopic and pathologic findings.
The study included 79 patients with AEN with a median (range) age of 64 years (12 to 91 years); 53 (67.1%) were men. Predominant presenting symptoms were hematemesis (49 of 79 [62.0%]), abdominal pain (29 [36.7%]), and melena (20 [25.3%]). Shock was the triggering event for AEN in 49 (62.0%). The 30- and 90-day mortality were 24.0% (19 of 79) and 31.6% (25), respectively. The presence of coexisting infection or bacteremia was significantly associated with 90-day mortality (P<.01). Endoscopically, involvement of the distal third only, distal two-thirds only, and entire esophagus was observed in 31.6% (24 of 76), 39.5% (30), and 29.0% (22), respectively. The length of esophageal involvement correlated with duration of hospitalization (P=.05). The endoscopic appearance of the esophageal mucosa ranged from predominantly white (21 of 44 [47.7%]) to mixed white and black (13 [29.6%]) to predominantly black (10 [22.7%]), and sloughing was present in 18 (40.9%). In the 26 patients with histopathologic findings available for review, 25 (96.1%) had necrosis and/or ulceration with abundant pigmentation. Among the 79 patients, 39 (49.4%) had a follow-up esophagogastroduodenoscopy; 26 of these 39 patients (66.7%) had resolution while 5 had persistent AEN, 4 of whom had improvement. Esophageal strictures developed in 7 of the 39 patients (18.0%).
Acute esophageal necrosis is a serious condition observed in critically ill patients. Its endoscopic appearance can be highly variable. In patients with an unclear diagnosis, esophageal biopsies may be helpful given the characteristic histologic findings.
描述急性食管坏死（AEN）患者的临床、内镜及组织学特征。
在这项回顾性队列研究中，纳入了1996年1月1日至2021年1月31日期间在明尼苏达州、佛罗里达州和亚利桑那州的梅奥诊所被诊断为AEN的患者。收集了患者的临床特征以及内镜和病理检查结果的数据。
该研究纳入了79例AEN患者，中位（范围）年龄为64岁（12至91岁）；53例（67.1%）为男性。主要的首发症状为呕血（79例中的49例[62.0%]）、腹痛（29例[36.7%]）和黑便（20例[25.3%]）。49例（62.0%）患者中，休克是AEN的触发事件。30天和90天死亡率分别为24.0%（79例中的19例）和31.6%（25例）。合并感染或菌血症与90天死亡率显著相关（P<0.01）。内镜检查发现，仅远端三分之一受累、仅远端三分之二受累以及整个食管受累的情况分别见于31.6%（76例中的24例）、39.5%（30例）和29.0%（22例）。食管受累长度与住院时间相关（P = 0.05）。食管黏膜的内镜表现从以白色为主（44例中的21例[47.7%]）到白色和黑色混合（13例[29.6%]）再到以黑色为主（10例[22.7%]），18例（40.9%）出现黏膜脱落。在26例有组织病理学检查结果可供复查的患者中，25例（96.1%）有坏死和/或溃疡并伴有大量色素沉着。在79例患者中，39例（49.4%）进行了随访食管胃十二指肠镜检查；这39例患者中有26例（66.7%）病情缓解，5例仍有持续性AEN，其中4例病情有所改善。39例患者中有7例（18.0%）发生了食管狭窄。
急性食管坏死是危重症患者中观察到的一种严重病症。其内镜表现可能高度多变。在诊断不明确的患者中，鉴于其特征性的组织学表现，食管活检可能会有所帮助。
