Endoscopic Treatment versus Surgical Repair of Esophageal Perforation: A Systematic Review.

Introduction: Esophageal perforation (EP) is considered a potentially fatal condition. The main causes areiatrogenic, spontaneous, foreign body (FB) ingestion, traumatic, and malignant. Treatment of choice is conventionaldue to different modalities available conservative treatment, surgical repair, and endoscopic treatment. Whilesurgical repair has traditionally been the recommended treatment for EP, endoscopic treatment is becoming onthe rise.Aim of work: To provide cumulative data about the efficacy and safety of endoscopic treatment versus surgicalrepair of EP.Patients and methods: This systematic review with meta-analysis was conducted at the Upper GIT SurgeryDepartment, Faculty of medicine, Ain Shams University. This is a systematic review of literatures published in therecent ten years and prepared carefully to follow the Cochrane Handbook for Systematic Reviews of Interventions.Results: Ten studies met the inclusion criteria with a total of 1452 patients (707 men, 728 women; mean age66.5 years). The most common etiology was spontaneous (36.8%), followed by iatrogenic cause (21%), and themost common location was middle part (47%). Endoscopic treatment and surgical repair were done in 871, 581patients respectively. The overall mean age was 66.5 years. There was a statistically significant higher complication(P=0.015) and longer length of hospital stay (P=0.008) in the surgical repair. Regarding mortality rate and failureof treatment, there was statistically insignificant difference among two groups (P=0.042) and (P=0.45).Conclusion: Surgical repair of EP was associated with more complications and longer hospital stay than theendoscopic treatment. Neither is superior, in lowering the mortality rate and treatment failure.