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ESOPHAGEAL PERFORATION – ANALYSIS OF ETIOLOGY, MANAGEMENT AND OUTCOME – A 10YRS EXPERIENCE AT A TERTIARY UNIVERSITY MEDICAL CENTER

Diana Voll 1, Max Alexander Kölling 1, Nora Friedrich 1, Polina Rösel 1, Thorsten Perl 1, Volker Ellenrieder 1, Maximilian von Heesen 1, Michael Ghadimi 1, Johanna Reinecke 1, Lena-Christin Conradi 1

Affiliations

1 University Medical Center Göttingen, Göttingen, Germany

Summary

AI Generated

A German tertiary center's 12-year retrospective analysis of 78 esophageal perforation cases identified iatrogenic causes as most common, with outcomes varying by etiology, location, and treatment modality.

Iatrogenic perforations were the leading cause (45 of 78 cases), primarily from endoscopic procedures, followed by Boerhaave's syndrome (23 cases), foreign body ingestion (5 cases), and tumor-associated perforations (4 cases).
Most perforations occurred in the lower esophagus (58 cases), with primary treatment consisting of endoscopic therapy in 38 cases, direct surgical management in 26 cases, and conservative approach in 14 cases, though 48 patients eventually underwent surgery.
Survival was poorest for spontaneous and tumor-associated perforations (mean 22-23 months) and best for foreign body-related perforations (mean 50 months), with mid-esophageal location, primary surgical treatment, and advanced age identified as risk factors for poorer outcomes.
Perforation-associated death occurred in 17 of 78 cases, and the authors note that endoscopic techniques have reduced surgical intervention needs in recent years while emphasizing the importance of multidisciplinary management and continuous treatment reassessment.

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Abstract

Introduction

Esophageal perforation is a rare condition with a high mortality rate. Often it has an iatrogenic origin, being caused by transesophageal echocardiography, different endoscopic and surgical procedures. Furthermore, there are other causes such as foreign body ingestion, tumor associated perforation and Boerhaave’s syndrome. Esophageal perforation can be difficult to diagnose since the clinical presentation is often unspecific. This can lead to a delay in appropriate treatment. Optimal management of this condition challenges clinicians in daily practice. Therefore, we present a monocentric retrospective study, evaluating our experience in treating esophageal perforations over more than a decade as a tertiary referral University Medical Center in Germany.

Aims & Methods

This study comprises the retrospective analysis of data from all patients treated for esophageal perforation in our clinic in the departments of general and visceral surgery and gastroenterology between 2012 and 2024. Only patients with confirmed esophageal perforation were included. Data was collected by means of a retrospective analysis of digital and analogous data archives as well as information from the physicians providing further treatment.

Results

A total of 78 cases (47 male, 31 female) of esophageal perforation were included. The leading cause was iatrogenic (n=45), consisting of endoscopic procedures (n=22), operative complications (n=11), TEE (n=6), diagnostic EGD (n=5) and one case of endotracheal intubation. The second most common cause of perforation was Boerhaave’s syndrome (n=23), followed by perforations associated with foreign body ingestion (n=5) or tumors of the esophagus (n=4). Traumatic perforations were rare (n=1). Most perforations occurred in the lower third of the esophagus (58 cases), 11 perforations were located in the mid esophagus and 9 in the upper third. Primary treatment consisted of direct surgical management in 26 cases (suture of the esophagus, gastrectomy, esophagectomy, definitive cervical esophagostomy, thoracic drainage, lavage), endoscopic therapy in 38 cases (Endo-VAC, stenting and application of OTSC or TTSC clips) and a conservative approach in 14 cases. Eventually a total of 48 patients underwent surgical treatment. Survival was poorest in spontaneous and tumor associated perforations (mean survival 22 and 23 months). Iatrogenic perforations showed an intermediate outcome. The best outcome was observed in perforations associated with foreign body ingestion (mean survival 50 months). In correlation with perforation location, the survival was best for perforations in the upper esophagus, followed by those in the lower esophagus, while lesions in the mid esophagus showed the worst outcome. Perforation associated death was recorded in 17 cases.

Conclusion

Esophageal perforations are a life-threatening event that require immediate and adequate treatment. Our analysis identified risk groups resulting in poorer survival: perforations in the mid esophagus, primary surgical treatment, advanced age. Within the last years, endoscopic techniques have reduced the need for surgical interventions. Nevertheless, surgical treatment remains the therapy of choice for patients not eligible for endoscopic treatment or after failure of endoscopic therapy. Our analysis emphasizes the importance of multidisciplinarity, close monitoring and continuous reassement of treatment strategy. Further investigation will help to improve the outcome via prospective studies or the establishment of a local or interregional database seem promising to underline suggestions derived from our analysis.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Endoscopy

Session

Quality in endoscopic practice

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Multidisciplinary clinics in liver cirrhosis: The new digital era in decompensated cirrhosis

Mattias Mandorfer 1

Affiliations

1 Medical University of Vienna, Vienna, Austria

Summary

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Abstract

Event

UEG Week Barcelona 2026

Topics

Hepatobiliary

Session

Advances in hepatology

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Marianna Arvanitakis 1

Affiliations

1 ERASME University Hospital, Université Libre de Bruxelles, Brussels, Belgium

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Endoscopy

Session

Quality in endoscopic practice

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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2026

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Words of welcome

Jörn Schattenberg 1, Maura Corsetti 2

Affiliations

1 Saarland University Medical Center, Homburg, Germany

2 University of Nottingham, Nottingham, United Kingdom

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Paediatrics Small Intestine & Nutrition Primary Care Small Intestine & Nutrition

Session

PGT Opening: How to make and not miss the diagnosis - Coeliac disease across the spectrum

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

Luming Huang 1, Libin Huang 1, Zhe Feng 1, Min Zhou 1, jingsun jiang 1, Xu Zeng 1, Zhiyin Huang 1, Chengwei Tang 1

Affiliations

1 West China Hospital, Sichuan University, Chengdu, China

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Abstract

Introduction

Our previous multi-center randomized clinical trial (RCT) has confirmed that cyclooxygenase-2 (COX-2) inhibitors effectively shortened the duration of organ failure (OF) in patients with severe acute pancreatitis (SAP). We intended to clarify whether early use of COX-2 inhibitor celecoxib could prevent the occurrence of acute pancreatitis (AP) related OF, thereby further reducing the incidence of SAP.

Aims & Methods

A prospective, multi-center, double-blind, randomized, placebo-controlled clinical trial was conducted in 20 hospitals in China. Predicted non-mild AP patients with an interval from symptom onset to enrollment ≤48 hours, no OF (modified Marshall score ≤1 for any organ), a score of ‌systemic inflammatory response syndrome (SIRS) ≥2 or modified harmless acute pancreatitis score (HAPS) ≥2 were eligible for this study. They were randomly assigned into celecoxib group (200mg celecoxib oral twice a day for 7days) or the same dosage and course of placebo to placebo group. If the patients developed OF, the double-blind trial medication was discontinued and replaced with celecoxib (200mg oral twice a day) until the OF was fully alleviated. All of the enrolled patients accepted conventional treatments. The primary outcome was the occurrence of OF.

Results

From September 2025 to April 2026, 278 predicted non-mild AP patients were enrolled and randomly divided into the placebo group (n=142) and celecoxib group (n=136). The occurrence of OF in celecoxib group (16.9%) was significantly reduced compared with those in placebo group (35.9%), p<0.001. Accordingly, the incidence of SAP was also significantly lower in the celecoxib group (5.9% vs 18.3%, p=0.002). In addition, the duration of OF in the celecoxib group (preventive) was significantly shorter than that of the placebo group (therapeutic) with median 1.0 days [IQR 1.0-2.4] vs 1.8 days [1.0-3.0], p=0.038. Subgroup analysis based on the interval from symptom onset to enrolment (≤24 hours or >24 hours) showed that the success rate of OF prevention of the celecoxib group was higher in the former.

Conclusion

Early use of COX-2 inhibitor celecoxib effectively decreased the occurrence of AP related OF, thus reducing the incidence of SAP. The earlier COX-2 inhibitor was used after AP onset, the better the effect it would have.

Event

UEG Week Barcelona 2026

Topics

Pancreas Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Acute pancreatitis: From prevention to treatment

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Giulio Antonelli

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

From scope to bedside: AI in direct patient care

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Not sure what you can access? Learn more about account types.

From scope to bedside: AI in direct patient care

Giulio Antonelli 1

Affiliations

1 Ospedale dei Castelli, Rome, Italy

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Endoscopy

Session

AI integration in my clinical practice today

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

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Giulio Antonelli