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Multimodal therapeutic options for esophageal perforations-a single-center experience
Maximilian Gruber1, Lars Kollmann1, Johan Friso Lock1
1Department of General-, Visceral-, Transplantation-, Vascular-, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
Frontiers in Surgery
|October 17, 2025
Summary
Spontaneous esophageal perforation (Boerhaave syndrome) and sepsis increase complication risks. Early endoscopic diagnosis and treatment are crucial, with surgery needed for severe cases to reduce mortality.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Emergency Medicine
Background:
- Esophageal perforation is a critical condition with high mortality.
- Treatment options span conservative, endoscopic, and surgical approaches.
- Comparing spontaneous vs. other esophageal perforations guides management.
Purpose of the Study:
- To compare multimodal management strategies for spontaneous esophageal perforations (Boerhaave syndrome) versus other esophageal perforations.
- To identify risk factors influencing outcomes in esophageal perforation patients.
Main Methods:
- Retrospective analysis of prospectively collected data from 32 patients (2010-2023).
- Comparison of spontaneous esophageal perforation (BS) and other esophageal perforation (OEP) groups.
- Primary endpoint: in-hospital mortality; Secondary endpoints: complications (CCI), nutrition, length-of-stay.
Main Results:
- Boerhaave syndrome patients had larger perforations and higher complication scores (CCI).
- In-hospital mortality was 9.4%, with a trend towards higher rates in BS (20.0%).
- BS and sepsis at admission independently predicted higher CCI scores.
Conclusions:
- Boerhaave syndrome and sepsis at admission are risk factors for complicated esophageal perforation.
- Endoscopy is preferred for diagnosis and initial treatment.
- Prompt surgical intervention is necessary for significant contamination or large defects.
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