Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
AuthorsVermeulen, Bram D
van der Leeden, Britt
Ali, Jawad T
Low, Donald E
Adler, Douglas G
Botha, Abraham J
D'Journo, Xavier B
Ferri, Lorenzo E
Haveman, Jan Willem
Kozarek, Richard A
Richardson, J David
Søreide, Jon A
Spaander, Manon C W
Tarascio, Jeffrey N
Tsai, Jon A
Siersema, Peter D
MetadataShow full item record
CitationVermeulen BD, van der Leeden B, Ali JT, et al. Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis [published online ahead of print, 2020 Jul 17]. Surg Endosc. 2020;10.1007/s00464-020-07806-y. doi:10.1007/s00464-020-07806-y
AbstractBackground: Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave's syndrome (BS). Methods: We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. Results: Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8-5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2-7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2-6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p < 0.001), compared with late TOD. In BS, no associations between TOD and outcomes were found. When combining IEP and BS, early TOD was associated with a 6% decrease in overall mortality (10% vs. 16%, OR 2.1, 95% CI 1.1-3.9), a 19% decrease in re-interventions (26% vs. 45%, OR 1.9, 95% CI 1.1-3.2) and a 35% decrease in mean length of hospital stay (16 vs. 22 days, p = 0.001), compared with late TOD. Conclusions: This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome. Keywords: Esophageal rupture; Individual patient data meta-analysis; Time of diagnosis.
DescriptionTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download
- Does the Pittsburgh Severity Score predict outcome in esophageal perforation?
- Authors: Wigley C, Athanasiou A, Bhatti A, Sheikh A, Hodson J, Bedford M, Griffiths EA
- Issue date: 2019 Feb 1
- Minimally invasive surgical management of spontaneous esophageal perforation (Boerhaave's syndrome).
- Authors: Elliott JA, Buckley L, Albagir M, Athanasiou A, Murphy TJ
- Issue date: 2019 Oct
- Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave's syndrome: an Italian single center case series study.
- Authors: Veltri A, Weindelmayer J, Alberti L, De Pasqual CA, Bencivenga M, Giacopuzzi S
- Issue date: 2020 Jul 1
- Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies.
- Authors: Biancari F, D'Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V, Saarnio J, Lucenteforte E
- Issue date: 2013 May
- Early versus late initiation of renal replacement therapy in patients with acute kidney injury-a systematic review & meta-analysis of randomized controlled trials.
- Authors: Bhatt GC, Das RR
- Issue date: 2017 Feb 28