Iatrogenic Esophageal Perforation

Abstract

Iatrogenic esophageal perforation is the most common cause of esophageal perforation associated with high mortality rate of 19%. Acute sudden onset of pain after endoscopic intervention is the most common presenting symptom. Water soluble contrast study, CT scan, and endoscopy provide a high sensitivity for diagnosis of iatrogenic perforation. Non-operative management is safe and effective treatment for early perforation (< 24 hours) without clinical signs of sepsis. However, surgical management such as primary repair esophageal exclusion and diversion, and esophagectomy is warranted in the patients who did not meet the criteria for non-operative management. Endoscopic management (clip, esophageal stent) is an alternative treatment option with 80 to 90% of esophageal healing rate. Early recognition of suspicious symptoms within 24 hours, the use of the appropriate investigation, selection of the optimal treatment options, and multidisciplinary critical care are the best way to improve outcomes.