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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-08-27

AUTHORS

Mircea Chirica, Matthieu Resche-Rigon, Benjamin Pariente, Fabienne Fieux, François Sabatier, Franck Loiseaux, Nicolas Munoz-Bongrand, Jean Marc Gornet, Marie-Dominique Brette, Emile Sarfati, Elie Azoulay, Anne Marie Zagdanski, Pierre Cattan

ABSTRACT

BackgroundEsophagectomy 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.MethodsIn 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.ResultsCompared 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.ConclusionThe decision to perform emergency esophagectomy for endoscopic high-grade corrosive esophageal injury should rely on CT findings. More... »

PAGES

1452-1461

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-014-3823-0

DOI

http://dx.doi.org/10.1007/s00464-014-3823-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1015262222

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25159655


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27 schema:description BackgroundEsophagectomy 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.MethodsIn 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.ResultsCompared 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.ConclusionThe decision to perform emergency esophagectomy for endoscopic high-grade corrosive esophageal injury should rely on CT findings.
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33 schema:keywords BackgroundEsophagectomy
34 CT evidence
35 CT findings
36 CT group
37 CT group patients
38 Kaplan-Meier method
39 MethodsIn
40 ResultsCompared
41 absence
42 age
43 agents
44 aim
45 analysis
46 better overall survival
47 blurring
48 breathing
49 care
50 computed tomography
51 consequences
52 corrosive esophageal injury
53 corrosive ingestion
54 crude analysis
55 death
56 decisions
57 depth
58 devastating consequences
59 diagnostic workup
60 emergency esophagectomy
61 endoscopy
62 enhancement
63 esophageal injury
64 esophageal necrosis
65 esophageal resection
66 esophagectomy
67 esophagus
68 evaluation
69 evidence
70 findings
71 gender
72 group
73 inaccuracy
74 ingested agent
75 ingestion
76 injury
77 method
78 native esophagus
79 necrosis
80 one-third
81 outcomes
82 overall survival
83 patients
84 primary outcome
85 resection
86 selection
87 standard of care
88 standards
89 study
90 study of patients
91 suicide
92 survival
93 tomography
94 tomography evaluation
95 transmural necrosis
96 unnecessary esophagectomy
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