Surgical Repair vs Stent for Esophageal Perforation: A Multi-institutional Database Analysis

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Medical Device Technology

Background:

• Esophageal perforation management often involves surgical repair.
• Endoscopic esophageal stenting is an emerging alternative, yet lacks extensive multi-institutional validation.
• Comparative outcome data between stenting and surgery are crucial for clinical decision-making.

Purpose of the Study:

• To compare the outcomes of surgical repair versus endoscopic esophageal stenting in patients diagnosed with esophageal perforation.
• To analyze mortality and other clinical outcomes using a large, nationally representative healthcare database.

Main Methods:

• A retrospective analysis of adult inpatients with esophageal perforation from the Premier Healthcare Database (2009-2019).
• Inclusion criteria focused on patients receiving either surgical repair or esophageal stenting within 7 days of admission.
• Logistic regression analysis was employed to assess the composite outcome of death or discharge to hospice, adjusting for patient comorbidities.

Main Results:

• The study identified 2543 patients, with 51.7% undergoing repair and 48.3% receiving stenting.
• While stenting use increased significantly from 2009 to 2019, initial analysis showed higher rates of death or hospice discharge post-stenting (16.2% vs. 10.2%).
• After adjusting for comorbidities, the adjusted odds of death or hospice discharge were statistically similar between esophageal stenting and surgical repair (OR, 1.074; P = .622), with stenting associated with a shorter hospital stay (P < .001).

Conclusions:

• Esophageal stenting and surgical repair demonstrate comparable rates of death or discharge to hospice for esophageal perforation when adjusted for comorbidities.
• Endoscopic stenting offers a potentially shorter hospital length of stay compared to surgical repair.
• These findings support esophageal stenting as a viable alternative to surgery for select patients with esophageal perforation.