Short- and long-term follow-up of patients with non-neoplastic esophageal perforation

Sebastian Brinkmann,Laura Knepper,Hans Fuchs,Daniel Pinto Dos Santos,Jessica Leers,Seung-Hun Chon,Patrick Plum,Arnulf Hoelscher,Kathrin Kuhr,Wolfgang Schroeder,Christiane Bruns

doi:10.1007/s00423-021-02327-1

Abstract

PurposeEsophageal perforation is associated with high morbidity and mortality. In addition to surgical treatment, endoscopic endoluminal stent placement and endoscopic vacuum therapy (EVT) are established methods in the management of this emergency condition. Although health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic intervention, not much is known about HRQoL, particularly in the long-term follow-up of patients treated for non-neoplastic esophageal perforation with different treatment strategies. The aim of this study was to evaluate patients’ outcome after non-neoplastic esophageal perforation with focus on HRQoL in the long-term follow-up.MethodsPatients treated for non-neoplastic esophageal perforation at the University Hospital Cologne from January 2003 to December 2014 were included. Primary outcome and management of esophageal perforation were documented. Long-term quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI), the Health-Related Quality of Life Index (HRQL) for patients with gastroesophageal reflux disease (GERD), and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires for general and esophageal specific QoL (QLQ-C30 and QLQ-OES18).ResultsFifty-eight patients were included in the study. Based on primary treatment, patients were divided into an endoscopic (n = 27; 46.6%), surgical (n = 20; 34.5%), and a conservative group (n = 11; 19%). Short- and long-term outcome and quality of life were compared. HRQoL was measured after a median follow-up of 49 months. HRQoL was generally reduced in patients with non-neoplastic esophageal perforation. Endoscopically treated patients showed the highest GIQLI overall score and highest EORTC general health status, followed by the conservative and the surgical group.ConclusionHRQoL in patients with non-neoplastic esophageal perforation is reduced even in the long-term follow-up. Temporary stent or EVT is effective and provides a good alternative to surgery, not only in the short-term but also in the long-term follow-up.

Highlights

Despite recent progress in surgical and endoscopic therapy, non-neoplastic esophageal perforation is still associated with high morbidity and mortality [1]
Patients who were treated for non-neoplastic esophageal perforation at the University Hospital Cologne between January 2003 and December 2014 were included in this study
Global health status (GHS) in the EORTC QLQ-C30 was lower for patients with non-neoplastic esophageal

Summary

Introduction

Despite recent progress in surgical and endoscopic therapy, non-neoplastic esophageal perforation is still associated with high morbidity and mortality [1]. Endoscopic, and conservative treatment strategies are available [2, 3]. Important for the outcome and for treatment choice is the extent of wound cavity, time of diagnosis, clinical inflammatory response, localization, and cause of perforation. There is a high variety of causes of esophageal perforation including spontaneous perforation, namely Boerhaave syndrome, iatrogenic perforation due to routine diagnostic endoscopy or transesophageal ultrasound, and rare traumatic causes. This variety leads to wide heterogeneity of treatment modalities resulting in an individualized treatment strategy for each patient based on cause of perforation. Treatment of esophageal perforation has changed from surgical treatment with diversion to more interventional treatment with stenting or endoscopic vacuum treatment

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