A 4-year single-center experience in the management of esophageal perforation

BACKGROUND: Esophageal perforation (EP) is a lethal surgical emergency that needs to be diagnosed and treated immediately. Diagnosis and treatment options for EP are limited due to its lower incidence. There are scoring systems proposed for this purpose; however, they cannot be applied to every patient. The recent trend in the treatment of EP is toward the non-operative approach over the surgical treatment methods. The purpose of the present study was to evaluate our treatment methods and outcomes in patients with EP.
METHODS: Thirteen patients with EP treated in our clinic between 2013 and 2017 were retrospectively reviewed. The Pittsburgh Perforation Severity Score (PSS), systemic condition status, and Clavien–Dindo Classification (CDC) score were assessed, and treatment methods were reviewed. Their effects on morbidity and mortality were examined using Fisher’s exact test and biserial correlation test.
RESULTS: A total of 13 patients (six males and seven females; median age 64 years) were included in the study. Ten patients were managed non-operative, and three were treated surgically. Of the 10 patients, two had additional surgery after non-operative management. The PSS, systemic condition status, CDC score, duration of stay in the hospital, time to diagnosis, presence of hypotension, and being in shock were strongly correlated with mortality (p<0.05). The PSS, CDC score, and stay in the intensive care unit were strongly correlated with morbidity (p<0.05). The comparison between the non-operative and operative groups did not yield a statistically significant difference in mortality and morbidity.
CONCLUSION: Even if the scoring systems help to understand the severity of the condition, they are inadequate to determine the treatment option. Early diagnosis and treatment are the most important steps in management. Operative and non-operative treatment options are not superior to each other, but their complementary use will be more beneficial for the patients.

Özofagus perforasyonlarý yönetiminde tek merkez 4 yýllýk deneyimimiz

AMAÇ: Özofagus perforasyonu (ÖP), hýzlý taný ve tedavi gerektiren, yaþamý tehdit eden acil cerrahi bir durumdur. Nadir görülmesi taný ve tedavi seçeneklerini sýnýrlamaktadýr. Bu amaçla bazý skorlama sistemleri önerilse de tüm hastalarda uygulanamamaktadýr. Son yýllarda ÖP tedavisinde non-operatif seçenekler operatif yöntemlere göre daha ön plana çýkmaktadýr. Bu çalýþmanýn amacý ÖP olan hastalarýna uygulanan tedavi yöntemlerini ve bunlarýn sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Kliniðimizde 2013 ve 2017 yýllarý arasýnda ÖP nedeniyle tedavi gören 13 hasta geriye dönük olarak deðerlendirildi. Pitsburg þiddet skorlamasý (PÞS), Sistemik kondisyon sýnýflamasý (SKS), Clavien-Dindo sýnýflamasý (KDS) tanýmlandý ve tedavi yöntemleri incelendi. Bu parametrelerin morbidite ve mortaliteyle olan iliþkileri Fisher tam olasýlýk testi ve çift serili korelasyon testi ile deðerlendirildi.
BULGULAR: Çalýþmaya toplamda 13 hasta (6 erkek, 7 kadýn; ortanca yaþ 64 yýl) dahil edildi. On hastada non-operatif tedavi seçenekleri uygulanýrken, üç hastaya cerrahi prosedürler uygulandý. Non-operatif tedavi seçenekleri uygulanan 10 hastadan ikisine sonrasýnda ek cerrahi prosedür uygulandý. Pitsburg þiddet skorlamasý, SKS, KDS skoru, hastanede kalýþ süresi, tanýya kadar geçen süre, hipotansiyon varlýðý ve þok mortalite ile koreleydi (p<0.05). Pitsburg þiddet skorlamasý, KDS skoru ve yoðun bakým ünitesinde kalým morbidite ile güçlü korelasyon göstermekteydi (p<0.05). Non-operatif ve operatif grup arasýnda mortalite ve morbidite açýsýndan anlamlý fark izlenmedi.
TARTIÞMA: Skorlama sistemleri hastalýðýn þiddetini belirlemede yardýmcý olsa da tedavi seçeneklerini belirlemede yetersiz kalmaktadýr. Erken taný ve tedavi hastalýðýn yönetiminde en önemli unsurdur. Operatif ve non-operatif prosedürlerin birbirine üstünlüðü yoktur. Fakat bu yöntemleri birbirlerinin tamamlayýcýsý olarak kullanmak hastalar açýsýndan daha faydalý olacaktýr.