Computed tomography evaluation of high-grade esophageal necrosis after corrosive ingestion to avoid unnecessary esophagectomy

被引:41
作者
Chirica, Mircea [1 ]
Resche-Rigon, Matthieu [2 ]
Pariente, Benjamin [3 ]
Fieux, Fabienne [4 ]
Sabatier, Francois [5 ]
Loiseaux, Franck [6 ]
Munoz-Bongrand, Nicolas [1 ]
Gornet, Jean Marc [3 ]
Brette, Marie-Dominique [7 ]
Sarfati, Emile [1 ]
Azoulay, Elie [8 ]
Zagdanski, Anne Marie [5 ]
Cattan, Pierre [1 ]
机构
[1] Univ Paris 07, St Louis Hosp, APHP, Dept Gen Endocrine & Digest Surg, Paris, France
[2] Univ Paris 07, St Louis Hosp, APHP, Dept Biostat & Med Informat,UMR 717,Inserm, Paris, France
[3] Univ Paris 07, St Louis Hosp, APHP, Dept Gastroenterol, Paris, France
[4] Univ Paris 07, St Louis Hosp, APHP, Dept Anesthesiol & Surg Intens Care, Paris, France
[5] Univ Paris 07, St Louis Hosp, APHP, Dept Radiol, Paris, France
[6] Univ Paris 07, St Louis Hosp, APHP, Dept Pathol, Paris, France
[7] Univ Paris 07, St Louis Hosp, APHP, Dept Otorhinolaryngol, Paris, France
[8] Univ Paris Diderot, St Louis Hosp, AP HP, Med ICU,Sorbonne Paris Cite,Fac Med, Paris, France
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2015年 / 29卷 / 06期
关键词
Computed tomography; Caustic esophagitis; Emergency management; UPPER GASTROINTESTINAL-TRACT; CAUSTIC INJURIES; RISK-FACTORS; CT; MANAGEMENT; SPECTRUM; SURGERY; STOMACH;
D O I
10.1007/s00464-014-3823-0
中图分类号
R61 [外科手术学];
学科分类号
摘要
Esophagectomy is the standard of care for high-grade corrosive esophageal necrosis as assessed endoscopically. However, the inaccuracy of endoscopy in determining the depth of intramural necrosis may lead to unnecessary esophageal resection, with devastating consequences. Our aim was to evaluate the use of computed tomography (CT) for the emergency diagnostic workup of endoscopic high-grade corrosive esophageal necrosis. In a before (2000-2007)/after (2007-2012) study of patients with grade 3b endoscopic esophageal necrosis, we compared outcomes after routine emergency esophagectomy versus selection for emergency esophagectomy based on CT evidence of transmural necrosis, defined as at least two of the following: esophageal-wall blurring, periesophageal-fat blurring, and the absence of esophageal-wall enhancement. Survival estimated using the Kaplan-Meier method was the primary outcome. Compared to the routine-esophagectomy group (n = 125), the CT group (n = 72) had better overall survival in the crude analysis (hazard ratio [HR], 0.43; 95 % confidence interval [95 %CI], 0.21-0.85; P = 0.015) and in the analysis matched on gender, age, and ingested agent (HR, 0.36; 95 %CI, 0.16-0.79; P = 0.011). No deaths occurred among patients managed without emergency esophagectomy based on CT findings, and one-third of CT-group patients had their functioning native esophagus at last follow-up. Self-sufficiency for eating and breathing was more common (84 % vs. 65 %; relative risk [RR], 1.27; 95 %CI, 1.04-1.55; P = 0.016) and repeat suicide less common (4 % vs. 15 %; RR, 0.27; 95 %CI, 0.09-0.82; P = 0.019) in the CT group. The decision to perform emergency esophagectomy for endoscopic high-grade corrosive esophageal injury should rely on CT findings.
引用
收藏
页码:1452 / 1461
页数:10
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