Background: Iatrogenic esophageal perforation accounts 60% of esophageal perforations and associated with 19% of mortality. Endoscopic procedures & invasive surgical maneuvers are the common causes. Pain, dysphagia and subcutaneous emphysema are common manifestations. Water soluble contrast study, CT scan, and endoscopy provide a high sensitivity for diagnosis. Early aggressive management within the first 24 hours is crucial for excellent outcomes; majority of patients is suitable for non-operative management while surgical intervention and esophageal stenting are alternative treatment options.
Aim of the work: To compare efficacy of different management modalities in patients with iatrogenic esophageal perforations.
Patient and Methods: Papers provided data from March 2007 to June 2022 related to patients with iatrogenic esophageal perforation & comparing different management modalities are reviewed between January 2021 and June 2022. We made pairwise meta-analyses of our outcomes using Comprehensive Meta-Analysis software (CMA version 3.9). Event rate with the corresponding 95% confidence intervals (95%CI) was also being calculated for categorical data.
Results: In majority of patients non-operative management is the best option with successful rate of more than 90% and lowest mortality (6.3%). Surgical management is warranted in the patients who do not meet the criteria for conservative treatment with successful rate of more than 80%. Esophageal stent is an alternative treatment option with 50 to 83% of esophageal healing.
Conclusions: The treatment method still has to be chosen on an individual basis. We recommend conservative treatment when indicated. Extended perforations should be treated with a surgical approach and esophageal stenting have a satisfactory outcome in suitable patients.