Endoscopic Treatment versus Surgical Repair of Esophageal Perforation: A Systematic Review.

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt

Abstract

Introduction: Esophageal perforation (EP) is considered a potentially fatal condition. The main causes are
iatrogenic, spontaneous, foreign body (FB) ingestion, traumatic, and malignant. Treatment of choice is conventional
due to different modalities available conservative treatment, surgical repair, and endoscopic treatment. While
surgical repair has traditionally been the recommended treatment for EP, endoscopic treatment is becoming on
the rise.
Aim of work: To provide cumulative data about the efficacy and safety of endoscopic treatment versus surgical
repair of EP.
Patients and methods: This systematic review with meta-analysis was conducted at the Upper GIT Surgery
Department, Faculty of medicine, Ain Shams University. This is a systematic review of literatures published in the
recent ten years and prepared carefully to follow the Cochrane Handbook for Systematic Reviews of Interventions.
Results: Ten studies met the inclusion criteria with a total of 1452 patients (707 men, 728 women; mean age
66.5 years). The most common etiology was spontaneous (36.8%), followed by iatrogenic cause (21%), and the
most common location was middle part (47%). Endoscopic treatment and surgical repair were done in 871, 581
patients respectively. The overall mean age was 66.5 years. There was a statistically significant higher complication
(P=0.015) and longer length of hospital stay (P=0.008) in the surgical repair. Regarding mortality rate and failure
of treatment, there was statistically insignificant difference among two groups (P=0.042) and (P=0.45).
Conclusion: Surgical repair of EP was associated with more complications and longer hospital stay than the
endoscopic treatment. Neither is superior, in lowering the mortality rate and treatment failure.

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