Spontaneous compared with iatrogenic esophageal perforation: A comparison between etiologies

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Esophageal perforation is a rare but serious condition with high mortality.
• Spontaneous perforations often involve greater mediastinal contamination than iatrogenic perforations.
• Timely intervention strategies differ significantly between spontaneous and iatrogenic esophageal perforations.

Purpose of the Study:

• To compare treatment strategies and patient outcomes between spontaneous and iatrogenic esophageal perforations.
• To identify factors influencing mortality and complication rates in esophageal perforation.
• To evaluate the effectiveness of nonoperative management for iatrogenic esophageal perforations.

Main Methods:

• Retrospective data collection from a tertiary center (2009-2021).
• Analysis of 73 esophageal perforation cases (42 spontaneous, 31 iatrogenic).
• Quantification of complications using the Comprehensive Complication Index and univariate analysis.

Main Results:

• Spontaneous perforations showed significantly higher 30-day mortality (21.4% vs 3.2%, P=.025).
• Iatrogenic perforations were more frequently managed nonoperatively (73.8% vs 22.6%, P<.001).
• Higher median Comprehensive Complication Index scores in spontaneous perforations (53.9 vs 29.6, P=.002).

Conclusions:

• Etiology of esophageal perforation does not impact long-term survival (90-day and 1-year mortality).
• The high rate of nonoperative management for iatrogenic perforations warrants further investigation into more aggressive treatment options.
• While spontaneous perforations present with greater initial severity, long-term outcomes are comparable to iatrogenic cases.