Nonoperative treatment for esophageal perforation caused by foreign bodies with or without infection was found to be safe and effective, according to a study published in Clinical and Translational Gastroenterology.

For the analysis, researchers retrospectively reviewed electronic medical records from 2012 to 2020 at the First Affiliated Hospital of Nanchang University in China. Patients (N=270) with esophageal perforation caused by foreign bodies who received nonoperative treatment were assessed for outcomes. Nonoperative treatment included endoscopic removal of foreign bodies, nasogastric tube placement, antibiotics, and proton pump inhibitors.

Patients had a mean age of 56±17 years, 53.3% were women, BMI was 21.6±4.0, 59.6% had chest pain, 18.1% foreign body sensation, 16.7% dysphagia, and 95.2% were diagnosed using computed tomography.


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Perforated esophagus was most commonly caused by fish bones (59.2%) or animal bones (23.7%), and most (61.5%) received treatment over 24 hours after perforation. The perforation occurred in the cervical (61.5%), thoracic (34.1%) or abdominal (4.4%) esophagus.

Complications of pyogenic esophagitis (32.5%), mediastinal or subcutaneous emphysema (18.9%), pneumonia (15.9%), pleural effusion (12.2%), pneumothorax (4.0%), and mediastinitis or empyema (1.1%) occurred after perforation.

Nonoperative treatment had an initial removal rate of 94.4% and total removal rate of 97.0%. Stratified by perforation location, foreign bodies in the thoracic region were removed more successfully (P =.047). Most perforations (94.8%) healed.

The most common adverse events were fever (13.3%), pleural effusion (4.4%), pneumonia (2.2%), sepsis (1.4%), and multisystem organ failure (1.1%). A secondary endoscopic intervention was required by 2.6% and 1.1% of patients died. The median hospital stay was 4 (IQR, 3-6) days.

Nearly half (n=127) of the cohort had infections. Patients with infection were older (P =.001), more were men (P =.017), fewer had perforations caused by fish bones (P =.011), they received treatment longer after their perforation (P <.001), they had higher white blood cell counts (P <.001), and were hospitalized longer (P =.005).

Infection was associated with individuals aged 66 years or older (odds ratio [OR], 2.196; 95% CI, 1.232-3.916; P =.008), male gender (OR, 1.934; 95% CI, 1.152-3.246; P =.013), time from perforation per 24 hours (OR, 1.126; 95% CI, 1.027-1.233; P =.011), and fish bones as the foreign body (OR, 0.557; 95% CI, 0.330-0.940; P =.028).

The findings in this study may not be generalizable due to cultural dietary habits, as the majority of perforations were caused by eating.

“…[N]onoperative treatment is safe and effective for esophageal perforation caused by foreign bodies,” the study authors wrote. “Even if perforation is combined with infection, active nonoperative treatment can also achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.”

Reference

Liao F, Zhu Z, Pan X, et al. Safety and efficacy of nonoperative treatment in esophageal perforation caused by foreign bodies. Clin Transl Gastroenterol. 2022;13(1):e00451. doi:10.14309/ctg.0000000000000451