From the Guidelines
Esophageal perforation is a serious medical condition that requires prompt attention. The risk factors for esophageal perforation include:
- Previous esophageal surgery or endoscopy
- Presence of esophageal disease such as esophagitis, stricture, or cancer
- Use of certain medications like bisphosphonates, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Advanced age
- Presence of other medical conditions like gastroesophageal reflux disease (GERD), achalasia, or scleroderma
- Trauma to the chest or abdomen
- Ingestion of caustic substances
- Use of nasogastric tubes or other medical instruments that may cause esophageal injury
- Eosinophilic esophagitis, with a history of food impaction and presence of a focal stricture being identified as risk factors associated with perforation 1
- Esophageal dilation, with a higher risk of perforation in caustic or radiation-induced strictures and pneumatic dilation for achalasia 1
- Endoscopic procedures, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which can increase the risk of perforation 1
- Peroral endoscopic myotomy (POEM), which can cause accidental small intraprocedural perforations of the mucosal flap and delayed barrier failure leading to highly morbid leaks, mediastinitis, and peritonitis 1
It is essential to approach patients with these risk factors with caution and closely monitor them for signs of esophageal perforation, such as severe chest pain, difficulty swallowing, or vomiting. If esophageal perforation is suspected, immediate medical attention is necessary to prevent further complications. Patients should be informed about the perforation risk and the potential need for endoscopic or operative intervention should a perforation occur 1.
From the Research
Risk Factors for Esophageal Perforation
The risk factors for esophageal perforation include:
- Advanced age, with patients over 65 years old being at higher risk 2
- Malignant perforation, which is associated with a higher mortality rate 2
- Pleural contamination, which increases the risk of composite morbidity 2
- Sepsis, which is a risk factor for composite morbidity 2
- Iatrogenic perforation, which can occur during endoscopy 3
- Traumatic injury, which can cause esophageal perforation 3
- Foreign body ingestion, which can lead to esophageal perforation 3
- Tumor perforation, which is a life-threatening condition 3
Etiology of Esophageal Perforation
The etiology of esophageal perforation can vary, including:
- Iatrogenic perforation during endoscopy 4, 3
- Boerhaave syndrome 3
- Traumatic injury 3
- Foreign body ingestion 3
- Tumor perforation 3
- Postemetic perforation 2
Management of Esophageal Perforation
The management of esophageal perforation depends on various factors, including the cause and location of the perforation, the time interval between the inciting event and presentation, and the overall medical stability of the patient 4. Treatment options include: