Aburumman Razan, Abdul Razzak Farah, Kerbage Anthony, Brunaldi Vitor, Mrad Rudy, Al Annan Karim, Abu Dayyeh Barham
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
Surg Endosc. 2025 Aug 25. doi: 10.1007/s00464-025-12090-9.
Esophageal perforation (EP) is a rare but life-threatening condition with an incidence of approximately 3.1 per million annually. While iatrogenic injury during endoscopy is the leading cause, other etiologies include spontaneous rupture, trauma, and malignancy. EP can present with nonspecific symptoms, most commonly chest pain or dysphagia, and diagnostic delays are associated with worse outcomes. Multiple non-operative strategies exist, including primary closure, stenting (bypass), combination therapy, and conservative management. However, data guiding the optimal approach remain limited. The aim of this study was to evaluate outcomes of different non-operative management strategies for EP and identify predictors of successful repair.
We retrospectively analyzed adult patients with EP across three Mayo Clinic sites between 2007 and 2023. Patients were categorized into four groups based on treatment modality. Demographics, clinical features, imaging, endoscopic intervention, and outcomes were recorded. The primary outcome was clinical success, defined as avoidance of surgical intervention. Logistic regression was used to identify predictors of success.
A total of 72 patients were included (mean age 63.7 years, 65.3% male). The most common cause was iatrogenic injury (58.3%), and the distal esophagus was the most frequent site (67.6%). Non-operative success was 100% in the primary closure and combination groups, and 42.9% in the conservative group (p < 0.001). On multivariate analysis, non-conservative therapy significantly predicted success (aOR 22.4, 95% CI [1.2-407.4], p = 0.036).
Primary closure and combination endoscopic approaches offer superior outcomes in managing EP. Early intervention with appropriate modality selection is critical to avoid surgical escalation and improve prognosis.
食管穿孔（EP）是一种罕见但危及生命的疾病，年发病率约为百万分之3.1。虽然内镜检查期间的医源性损伤是主要原因，但其他病因包括自发性破裂、创伤和恶性肿瘤。EP可表现为非特异性症状，最常见的是胸痛或吞咽困难，诊断延迟与更差的预后相关。存在多种非手术策略，包括一期缝合、支架置入（旁路）、联合治疗和保守治疗。然而，指导最佳治疗方法的数据仍然有限。本研究的目的是评估EP不同非手术治疗策略的结果，并确定成功修复的预测因素。
我们回顾性分析了2007年至2023年期间梅奥诊所三个院区的成年EP患者。根据治疗方式将患者分为四组。记录人口统计学、临床特征、影像学、内镜干预和结果。主要结局为临床成功，定义为避免手术干预。采用逻辑回归确定成功的预测因素。
共纳入72例患者（平均年龄63.7岁，65.3%为男性）。最常见的病因是医源性损伤（58.3%），食管远端是最常见的部位（67.%）。一期缝合组和联合治疗组的非手术成功率为100%，保守治疗组为42.9%（p<0.001）。多因素分析显示，非保守治疗显著预测成功（调整后比值比22.4,95%可信区间[1.2-407.4]，p=0.036）。
一期缝合和联合内镜治疗方法在EP治疗中效果更佳。早期选择合适的治疗方式进行干预对于避免手术升级和改善预后至关重要。
