Outcome of Treatment Modalities for Spontaneous Esophageal Rupture: a Meta-analysis and Case Series

Overview

Journal Int J Surg

Specialty General Surgery

Date 2024 Jul 25

PMID 39051903

Authors

Jiajian Pan

Yong Ge

Tianci Feng

Chengwen Zheng

Xueqiu Zhang

Shoujie Feng

Teng Sun

Feng Zhao

Zhengbu Sha

Hao Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity.

Objective: To describe our institution's experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options.

Methods: The authors enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. The authors also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before 1 April 2024, for inclusion in the meta-analysis.

Results: This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, the authors obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% CI: 0.08-0.15). The combined reintervention rate was 11% (95% CI: 0.05-0.19). The combined immediate mortality was 6% (95% CI: 0.04-0.09) after primary closure, 14% (95% CI: 0.02-0.32) after T-tube drain repair, 2% (95% CI: 0.00-0.15) after esophagectomy, 8% (95% CI: 0.03-0.15) after stent placement, and 22% (95% CI: 0.03-0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01-0.08), whereas that in patients initiating treatment >24 h later was 12% (95% CI: 0.08-0.18).

Conclusion: Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.

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