Esophageal perforation: a retrospective report of outcomes at a single center

Background: Esophageal perforation is associated with high morbidity and mortality. The aim of this study was to evaluate the outcomes of patients who underwent treatment for esophageal perforation at a tertiary referral hospital. Methods: A patient database was queried for patients treated for esophageal perforation between May 2014 and September 2017. Charts were retrospectively reviewed. The Pittsburgh perforation severity score (PSS) was calculated to assess the degree of perforation severity for each patient. Results: In total, 56 patients with esophageal perforation met inclusion criteria for this study. Thirty-nine patients (69.6%) were men, the mean age of the patients was 60 years. The most common causes of esophageal perforation were iatrogenic (24/56, 42.9%) and Boerhaave syndrome (12/56, 21.4%). The most common site of perforation was the thoracic esophagus (38/56, 67.9%). Eight patients were treated conservatively, a stent-only approach was used in 8 patients, and 40 patients underwent surgery. Seventeen/40 of these patients underwent debridement and drainage; 8 of those 17 also received stenting of the perforation site. Primary repair was used in 16 patients. Of these 16 patients, 2 also received a stent. Seven patients underwent esophagectomy. Overall mortality within 1 month was 5.4% (3 patients); this was similar to the predicted value. Subgroup comparison failed to reveal a significant advantage of stent use. Conclusions: The leading causes of esophageal perforation were iatrogenic injury and Boerhaave syndrome. The Pittsburgh PSS correlated well with the need for aggressive surgical intervention and length of stay in the intensive care unit.