BACKGROUND: The management and clinical outcome of patients suffering esophageal trauma depends on a prompt diagnosis. The detection of esophageal injuries by clinical examination, esophagography, or computed tomography is limited. This study aimed to assess the yield and clinical utility of flexible esophagoscopy (FE) in the diagnosis of traumatic esophageal injuries. PATIENTS: During 7 years, we conducted a retrospective (1998-2003) and prospective (2003-2005) study of 163 victims admitted to a trauma hospital, and submitted to FE because of suspected esophageal trauma. Esophageal injury was defined as laceration or perforation, hematoma, abrasion, hematin spots, or ecchymosis. The endoscopic diagnosis was compared with surgical findings or clinical follow-up. RESULTS: No traumatic lesion was observed in 139 patients (85.3%), esophageal injuries were detected in 23 (14.1%), and one examination was inconclusive (esophageal stricture, 0.6%). Lacerations were detected in 14 patients and confirmed surgically. Esophageal contusion was observed in nine patients and out of these, five patients underwent surgical exploration and four were managed nonoperatively. The assessment of esophageal injury by FE demonstrated 95.8% sensitivity, 100% specificity, 99.3% accuracy, 100% positive predictive value, and 99.2% negative predictive value. The likelihood ratio for a negative examination was 0.041 and the Youden J Index was 99.2%. CONCLUSIONS: FE appears to be an accurate diagnostic tool in the assessment of esophageal injuries. Two main lesions were noted: laceration and contusion. Laceration requires surgical repair. Contusion represents a nonperforative injury of the esophageal wall, requires correlation with computed tomography, and may be managed nonoperatively.
BACKGROUND: The management and clinical outcome of patients suffering esophageal trauma depends on a prompt diagnosis. The detection of esophageal injuries by clinical examination, esophagography, or computed tomography is limited. This study aimed to assess the yield and clinical utility of flexible esophagoscopy (FE) in the diagnosis of traumatic esophageal injuries. PATIENTS: During 7 years, we conducted a retrospective (1998-2003) and prospective (2003-2005) study of 163 victims admitted to a trauma hospital, and submitted to FE because of suspected esophageal trauma. Esophageal injury was defined as laceration or perforation, hematoma, abrasion, hematin spots, or ecchymosis. The endoscopic diagnosis was compared with surgical findings or clinical follow-up. RESULTS: No traumatic lesion was observed in 139 patients (85.3%), esophageal injuries were detected in 23 (14.1%), and one examination was inconclusive (esophageal stricture, 0.6%). Lacerations were detected in 14 patients and confirmed surgically. Esophageal contusion was observed in nine patients and out of these, five patients underwent surgical exploration and four were managed nonoperatively. The assessment of esophageal injury by FE demonstrated 95.8% sensitivity, 100% specificity, 99.3% accuracy, 100% positive predictive value, and 99.2% negative predictive value. The likelihood ratio for a negative examination was 0.041 and the Youden J Index was 99.2%. CONCLUSIONS:FE appears to be an accurate diagnostic tool in the assessment of esophageal injuries. Two main lesions were noted: laceration and contusion. Laceration requires surgical repair. Contusion represents a nonperforative injury of the esophageal wall, requires correlation with computed tomography, and may be managed nonoperatively.
Authors: Diego E Gomez; Nicola C Cribb; Luis G Arroyo; André Desrochers; Gilles Fecteau; Sylvain Nichols Journal: Can Vet J Date: 2014-10 Impact factor: 1.008
Authors: Mircea Chirica; Michael D Kelly; Stefano Siboni; Alberto Aiolfi; Carlo Galdino Riva; Emanuele Asti; Davide Ferrari; Ari Leppäniemi; Richard P G Ten Broek; Pierre Yves Brichon; Yoram Kluger; Gustavo Pereira Fraga; Gil Frey; Nelson Adami Andreollo; Federico Coccolini; Cristina Frattini; Ernest E Moore; Osvaldo Chiara; Salomone Di Saverio; Massimo Sartelli; Dieter Weber; Luca Ansaloni; Walter Biffl; Helene Corte; Imtaz Wani; Gianluca Baiocchi; Pierre Cattan; Fausto Catena; Luigi Bonavina Journal: World J Emerg Surg Date: 2019-05-31 Impact factor: 5.469
Authors: Mauricio Millán; Michael W Parra; Boris Sanchez-Restrepo; Yaset Caicedo; Carlos Serna; Adolfo González-Hadad; Luis Fernando Pino; Mario Alain Herrera; Fabian Hernández; Fernando Rodríguez-Holguín; Alexander Salcedo; José Julián Serna; Alberto García; Carlos A Ordoñez Journal: Colomb Med (Cali) Date: 2021-06-30