Surgical versus endoscopic management of esophageal perforation

The management of esophageal perforation is a topic of debate, as there now are viable surgical and endoscopic options. Historically, surgical management had been considered the standard of care for these perforations, but such surgical management can be associated with considerable morbidity. In this report, we explore contemporary options for the care of patients with esophageal perforations.

Innovations in endoscopic therapies, including self-expanding metal and plastic stents, over-the-scope clips, vacuum therapy, and endoscopic suturing have expanded treatment options for esophageal perforations. These approaches are particularly beneficial for selected patients with early, contained perforations, offering reduced morbidity and shorter hospital stays. However, surgical intervention remains essential in cases of extensive contamination, necrosis, or delayed diagnosis. A growing body of evidence supports a patient-specific approach, integrating both traditional and emerging interventions.

The management of esophageal perforation is evolving with the increasing use of minimally invasive endoscopic techniques. However, surgical repair remains the definitive treatment in patients with hemodynamic instability or extensive contamination. Timely intervention is critical, as delayed diagnosis significantly increases morbidity and mortality. A tailored approach, incorporating patient-specific factors and nature of the disease, ensures optimal outcomes.