P164 Esophageal perforations. Fighting between time, severity and individualization: a collective interhospital Upper GI Unit experience.

Abstract

Aim

Esophageal perforation is a serious injury associated with high morbidity and mortality. The management ranges from observation to operative treatment. The aim of this study was to evaluate safety and efficacy of different treatment strategies in patients with esophageal perforation depending on the severity and time from diagnosis to treatment.

Background & Methods

We performed a retrospective review of a prospective esophageal perforation database from two Upper GI Units between 01/01/2014 and 31/12/2018. Patients admitted for esophageal perforation were identified and reason of perforation, perforation site, time of diagnosis, management, length of stay (LOS) and outcomes were recorded.

Results

Sixteen patients were identified. Reason of perforation was Boerhaave's syndrome in n=9 (56.2%), iatrogenic in n=4 (25%) and foreign body in n=2 (12.5%) patients. Perforation site was distal esophagus in n=11 (68.7%) mid- esophagus in n=3 (18.7%) and Upper esophagus in n=2 (12.5%) patients. Time from perforation to diagnosis was 24h in n=12 (75%) and 48h in n=4 (25%) patients. Treatment in patients diagnosed the first 24h was esophagectomy in n=5 (41.6%), primary closure in n=2 (16.6%) and feeding tube along with thoracotomy and washout in n=2 (16.6%). Conservative management was offered in n=2 (16.6%). Patients diagnosed after 24h were managed with chest drains (50%) and stent insertion (50%). Mean LOS in patients that required surgical intervention was 18.2 days (Range: 6-60), while mean LOS in those who did not required was 11.1 days (Range: 1-37) Eleven (68.7%) patients were discharged in good clinical condition.

Consclusion

Esophageal perforations should be treated in specialized Upper GI Units due to the severity of the injury. Treatment plan should be individualized.