Abstract:
:Esophageal perforation is an uncommon and challenging surgical emergency associated with high rates of morbidity and mortality. At present, no consensus exists on optimal management of the condition. The Pittsburgh Severity Score (PSS) is a tool intended to stratify perforation severity and guide treatment. However, there is a paucity of literature examining the validity of the score or its application in a UK population. This study aims to validate the PSS and explore its use in stratifying patients with esophageal perforation into distinct subgroups with differential outcomes in an independent UK study population.All patients treated for esophageal perforation at Queen Elizabeth Hospital, Birmingham between September 2003 and October 2017 were included in this study. Cases were identified using a combination of ICD-10 and OPCS informatics search codes and prospective case collection. Data relating to the clinical presentation, diagnosis, management, and outcome of cases were recorded using a preformed data collection form. PSS predictive performance was assessed against five outcomes: rates of post-perforation and post-operative complications, in-hospital mortality, length of intensive care (ICU/HDU) stay, and total length of hospital stay.A total of 87 cases were identified, consisting of 48 (55%) iatrogenic perforations, 24 (28%) cases of spontaneous (Boerhaave's) perforation, and 15 perforations due to other etiologies (17%). Operative management was favored in this series, with 47% of all perforations being treated surgically. Overall in-hospital mortality was 13%, coupled with a median length of hospital stay of 24 days (interquartile range [IQR]: 12-49), of which a median of 2 days was spent in intensive care facilities (IQR: 0-14). A total of 46% of patients developed post-perforation complications, with 59% of the operatively managed cohort developing complications post-operatively.The PSS was not found to be significantly predictive of post-perforation complications (area under the ROC curve [AUROC]: 0.62, p = 0.053) or in-hospital mortality (AUROC: 0.69, p = 0.057) for the cohort as a whole. However, a subgroup analysis found the accuracy of the PSS to vary considerably by etiology, being significantly predictive of post-perforation complications within the subgroup of Boerhaave's perforations (AUROC: 0.86, p = 0.004).In conclusion, we found that the PSS has some utility in stratifying esophageal perforation severity and predicting specific patient outcomes. However, it appears to be of more value when applied to the subgroup of patients with Boerhaave's perforations.
journal_name
Dis Esophagusjournal_title
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagusauthors
Wigley C,Athanasiou A,Bhatti A,Sheikh A,Hodson J,Bedford M,Griffiths EAdoi
10.1093/dote/doy109subject
Has Abstractpub_date
2019-02-01 00:00:00issue
2eissn
1120-8694issn
1442-2050pii
5212887journal_volume
32pub_type
杂志文章abstract::Dysplasia and esophageal adenocarcinoma may arise in patients with Barrett's esophagus after fundoplication esophageal pH monitoring showing no acid in esophagus. This suggests the need to develop methodology to evaluate the occurrence of ultra-distal reflux (1cm above the LES). The objective of the study was to compa...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2010.01160.x
更新日期:2011-08-01 00:00:00
abstract::The aim of this study was to determine the influence of splenectomy on perioperative morbidity and mortality, as well as on the long-term survival after esophageal resection for carcinoma of the esophagus. From September 1985 to July 2003, 404 patients underwent surgery for esophageal carcinoma in our institution. Spl...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2005.00512.x
更新日期:2005-01-01 00:00:00
abstract::We conducted a retrospective analysis to assess the toxicity and long-term survival of esophageal squamous cell carcinoma patients treated with three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) versus conventional two-dimensional radiotherapy (2DRT). All data in the present st...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/dote.12435
更新日期:2016-11-01 00:00:00
abstract::Botulinum toxin (BT) injection is an alternative treatment of achalasia. The aim of the study was to examine outcomes of patients treated with BT in the Czech Republic. Since 1997, 49 patients with achalasia have been treated with BT. We prospectively evaluated the effect of BT injection on 41 patients during a median...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1046/j.1442-2050.2003.00329.x
更新日期:2003-01-01 00:00:00
abstract::Salvage esophagectomy (SALV) is potentially beneficial for patients with residual or relapsed esophageal carcinoma after definitive chemoradiotherapy (dCRT), although preoperatively identifying good candidates for SALV remains difficult. We investigated the prognostic impacts of inflammatory and nutritional status in ...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/doy066
更新日期:2019-04-01 00:00:00
abstract::The impact of body weight on outcomes after robotic-assisted esophageal surgery for cancer has not been studied. We examined the short-term operative outcomes in patients according to their body mass index following robotic-assisted Ivor-Lewis esophagectomy at a high-volume tertiary-care referral cancer center and eva...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/dote.12484
更新日期:2017-01-01 00:00:00
abstract::Esophageal squamous cell carcinoma (ESCC) is one of the most frequently diagnosed cancers in China, but the etiology and mode of carcinogenesis of this disease remain poorly understood. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN), as a negative regulator of Akt/mTOR pathway, frequently mutates or is...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/dote.12448
更新日期:2017-02-01 00:00:00
abstract::The authors report a case of schistosomiasis of uncommon location. A patient submitted to esophagectomy for Chagas' megaesophagus was found to have eggs of Schistosoma mansoni upon pathologic examination of the surgical specimen. The authors discuss the anatomopathological aspects of schistosomiasis, as well as its oc...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/10.1.71
更新日期:1997-01-01 00:00:00
abstract::It is well accepted that recurrent laryngeal nerve paralysis is a severe complication of esophagectomy or lymphadenectomy performed adjacent to the recurrent laryngeal nerves. Herein, determination of the effectiveness of implementing continuous recurrent laryngeal nerve monitoring to reduce the incidence of recurrent...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2012.01414.x
更新日期:2014-07-01 00:00:00
abstract::Although swallowing difficulties have been described in patients with Kearns-Sayre syndrome (KSS), the spectrum of manometric characteristics of dysphagia is not yet well known. Moreover, it is conceivable that a combination of various degrees of swallowing difficulties with different patterns in manometric studies ex...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2001.00152.x
更新日期:2001-01-01 00:00:00
abstract::The placement of metal stents is often used as a palliative treatment for malignant esophageal stenosis. We designed a novel stent that has been used clinically since 2011, and we therefore performed a retrospective study to compare the therapeutic effects of this novel metal stent to a conventional partially covered ...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/dote.12446
更新日期:2017-02-01 00:00:00
abstract::Day-case esophageal surgery has been demonstrated to be safe in small prospective cohorts and only for laparoscopic fundoplication. The aims of this study are to assess the feasibility and safety of a large series of esophageal day-case surgeries, including laparoscopic Nissen fundoplication (LNF), Zenker diverticulec...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/dow036
更新日期:2017-04-01 00:00:00
abstract::Esophageal leiomyoma are usually intramural and the most common minimally invasive approach is thoracoscopic excision leaving the mucosa intact. We report the case of a 58-year-old woman who underwent laparoscopic excision of a pedunculated esophageal leiomyoma. ...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1046/j.1442-2050.2001.00203.x
更新日期:2001-01-01 00:00:00
abstract::Achalasia may present in a non-advanced or an advanced (end stage) stage based on the degree of esophageal dilatation. Manometric parameters and esophageal caliber may be prognostic for the outcome of treatment. The correlation between manometry and disease stage has not been yet fully studied. This study aims to desc...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/dow008
更新日期:2017-05-01 00:00:00
abstract::Barrett's esophagus (BE) is a premalignant condition associated with the development of esophageal adenocarcinoma (EAC). Previous studies have implicated hydrophobic bile acids and gastric acid in BE and EAC pathogenesis. In this study, we tested the hypothesis that DNA damage, cytotoxicity and oxidative stress induce...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2009.00993.x
更新日期:2010-02-01 00:00:00
abstract::The outcome of 211 patients undergoing laser therapy as palliation for inoperable carcinoma of the esophagus is presented. The median age was 73 (range 44-97). The histology was adenocarcinoma for 127 patients and squamous-cell carcinoma for 84 patients. For 133 patients, laser was the only therapy while 56 patients h...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/10.4.243
更新日期:1997-10-01 00:00:00
abstract::(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is used for pre-treatment staging and evaluation of response to pre-operative therapy in advanced thoracic esophageal cancers. To evaluate the clinical significance of PET diagnosis of superficial thoracic esophageal cancers, FDG-PET was conducted preop...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2007.00743.x
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abstract::Guidelines for eosinophilic esophagitis (EoE) require high-dose PPI (HD-PPI) trial to evaluate for PPI-responsive esophageal eosinophilia (PPI-REE) prior to EoE diagnosis and dedicated therapy. This involves a second esophagogastroduodenoscopy (EGD) to assess for PPI-REE. This study is to evaluate adherence to current...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/doy029
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/doy075
更新日期:2019-04-01 00:00:00
abstract::beta-Catenin, which is frequently overexpressed in a variety of human cancers including esophageal cancer, mediates cancer cell proliferation and tumor growth. In the present study, we used a human U6 promoter-driven DNA-template approach to induce short hairpin RNA (shRNA)-triggered RNA interference to silence beta-c...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/doz067
更新日期:2020-03-16 00:00:00
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journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1046/j.1442-2050.2003.00297.x
更新日期:2003-01-01 00:00:00
abstract::Local failure after definitive chemoradiotherapy (CRT) for stage IB, II, and III esophageal cancer is one of the causes of poor outcome. Endoscopic mucosal resection (EMR) is an effective treatment for superficial esophageal cancer. However, its feasibility as a salvage treatment for local recurrent or residual tumors...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/dote.12037
更新日期:2014-01-01 00:00:00
abstract::Our experience with videolaparoscopic operations for hiatus hernia and achalasia, which have almost replaced classical procedures, enabled us to use the same technique for other interventions in the distal third of the thoracic esophagus. Thus, we were able to treat epiphrenic diverticulum using a minimally invasive a...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1046/j.1442-2050.2002.00275.x
更新日期:2002-01-01 00:00:00
abstract::We report the case of a 63-year-old man who presented with weakness, fatigue, dehydration, confusion, abdominal pain, congestive heart failure and hypercalcemia. He expired and autopsy revealed an exulcerating carcinoma of the esophagus, invading the esophageal wall and metastasizing to the lungs, skin and lymph nodes...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2003.00363.x
更新日期:2003-01-01 00:00:00
abstract::The management of achalasia remains controversial, with little consensus on the optimal patient treatment pathway. In our own esophageal unit, we offer pneumatic dilatation as the initial therapy in most patients as first-line therapy. In this study, we aimed to examine the safety and efficacy of our own approach to t...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2010.01055.x
更新日期:2010-08-01 00:00:00
abstract::The overall metastatic potential of surgically treated early esophageal adenocarcinoma has not been studied in detail. This paper therefore assessed lymph node metastases at surgery, loco regional and distant metastases, in order to assess the metastatic potential of early esophageal adenocarcinoma. Two hundred and se...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/doy127
更新日期:2019-11-13 00:00:00
abstract::In a series of 378 patients with esophageal carcinoma, 43 patients with head and neck carcinoma were divided into two groups: 30 patients without symptoms whose esophageal or head and neck second primary carcinomas were incidentally detected by an endoscopic examination for the second carcinoma (group 1) and 13 patien...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1046/j.1442-2050.1999.00045.x
更新日期:1999-01-01 00:00:00
abstract::Target volume definition in modern radiotherapy is based on planning computed tomography (CT). So far, 18-fluorodeoxyglucose positron emission tomography (FDG-PET) has not been included in planning modality in volume definition of esophageal cancer. This study evaluates fusion of FDG-PET and CT in patients with esopha...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1111/j.1442-2050.2009.01044.x
更新日期:2010-08-01 00:00:00
abstract::Thoracoscopic repair of esophageal atresia is gaining popularity worldwide attributable to availability and advances in minimally invasive instruments. In this report, we presented our experience with thoracoscopic esophageal atresia/tracheoesophageal fistula (EA/TEF) repair in our tertiary care institute. A prospecti...
journal_title:Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
pub_type: 杂志文章
doi:10.1093/dote/doaa001
更新日期:2020-02-12 00:00:00