SHORT-TERM AND LONG-TERM OUTCOME OF ESOPHAGEAL-PERFORATION

Esophageal perforation is an important complication of endoscopy and dilation, but few data are available regarding long-term outcome in these patients. Thirty-one consecutive patients with esophageal perforation were studied. Long-term outcome was determined by office follow-up and questionnaires via mail or telephone. The study group included 16 men and 15 women with a mean age of 61 +/- 4 years. Instrumentation was the principal cause of perforation (77%), and pain was the principal symptom in the majority of cases. However, some patients reported no pain, their only symptom being shortness of breath or dysphagia on swallowing saliva. Contrast examinations were used to establish the diagnosis, but results were initially negative in 3 of 27 patients (11%). Seven patients were treated nonsurgically (nasogastric drainage, antibiotics, and intravenous alimentation). Fourteen patients underwent primary closure of the esophageal rent. Six patients underwent surgical drainage, 3 underwent total esophagectomy, and 1 died during surgery before the esophagus was exposed. Thirty-day mortality was 6.4%. Mean hospital stay was 26 +/- 5 days. Postdischarge follow-up was available in 28 of the 29 patients (97%) surviving initial hospitalization, and the mean follow-up was 47 +/- 9 months. Nineteen patients had persistent dysphagia, and 6 underwent dilation again. One of these patients had a second perforation. Contrary to results of some earlier studies, the mortality from esophageal perforation was low in our study because of early intervention in suspected cases. Results of contrast studies are sometimes negative in the early stages after perforation, and studies may need to be repeated. Long-term dysphagia is a difficult problem in patients with strictures, and some patients need further dilation, with the risk for another perforation. In contrast, long-term dysphagia is rare in patients with barogenic perforation.