ASGE Annual GI Advanced Practice Provider Course (Virtual) - Clinical Case-based Learning (Day Two) | March 2025-Management of Esophageal Perforation

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Video Summary

Esophageal perforations are life-threatening emergencies that can lead to severe complications, including sepsis, mediastinitis, pleural effusion, and organ failure. The most common cause is iatrogenic, occurring during procedures like endoscopy. Early recognition and treatment are crucial for patient outcomes. Symptoms include severe chest pain, dysphagia, fever, and signs of sepsis. Imaging, such as a CT with contrast or an esophagram, is essential for diagnosis. Initial management focuses on stabilization, including strict NPO, IV fluids, and antibiotics.<br /><br />Endoscopic management is preferred for stable patients, using techniques such as clips for acute perforations, suturing for larger defects, and esophageal stents for perforations unsuitable for primary closure. Newer methods like endoluminal vacuum-assisted closure are available for persistent cases. Multidisciplinary involvement, including thoracic surgery and GI specialists, improves outcomes. Treatment plans are individualized, with conservative management favored when appropriate, especially in clinically stable patients without signs of active leakage.

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Katelyn Cookson, PA-C

Keywords

esophageal perforations

iatrogenic causes

endoscopic management

multidisciplinary approach

imaging diagnosis

conservative treatment