ORIGINAL RESEARCH article
Front. Surg.
Sec. Visceral Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1662261
Multimodal therapeutic options for esophageal perforations – a single center experience
Provisionally accepted
Maximilian Gruber1
Lars Kollmann1
Johan Friso1
Sven Flemming1
reimer Stanislaus1Armin Wiegering2Alexander Meining1Ivan Aleksic1Christoph-Thomas Germer1
Florian Johannes David Seyfried1*- 1University Hospital Würzburg, Würzburg, Germany
- 2Universitatsklinikum Frankfurt, Frankfurt, Germany
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Background: Esophageal perforation is a life-threatening condition with high mortality. The current therapeutical options range from conservative over endoscopic to surgical treatment. We aimed to compare specific patterns of multimodal management of spontaneous vs. other esophageal perforations. Methods: All consecutive patients diagnosed with either spontaneous (Boerhaave syndrome, BS) vs. other esophageal perforation (OEP) between 2010 and 2023 were prospectively collected and retrospectively analyzed. The primary endpoint was in-hospital mortality. Secondary endpoints were overall complications (Comprehensive Complication Index, CCI), therapy-associated complications, oral nutrition at discharge and length-of-stay (LOS). Results: 32 patients were identified, of whom 15 were diagnosed with BS and 17 with OEP. Initially, 11/32 (34.4%) were primarily treated endoscopically, 12/32 (37.8%) with surgery and 8/32 (25.0%) with a combined treatment. Patients with BS had larger perforations (22.50 vs. 15.00 mm, p=.05) and higher complication scores (CCI: 61.80 vs. 45.60, p=.076). Over the course, the primary therapeutic regimen (endoscopic, local surgical treatment) had to be escalated in 36.4% of patients. Overall, in-hospital mortality was 9.4% (3/32 patients) with a strong trend towards a higher mortality in patients with BS (20.0 vs. 0.0%, p=.053). Diagnosis of BS and sepsis at admission (β=28.387, p=.012) were independent risk factors for higher CCI. Conclusions: BS and sepsis at admission are risk factors for a complicated course. Endoscopy is the first choice for diagnosis and initial treatment. Patients with mediastinal gross contamination or large defects usually need surgical intervention, which should not be delayed.
Keywords: Esophageal Perforation, Boerhaave syndrome, endovac, Esophagectomy, EVT
Received: 08 Jul 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Gruber, Kollmann, Friso, Flemming, Stanislaus, Wiegering, Meining, Aleksic, Germer and Seyfried. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Florian Johannes David Seyfried, University Hospital Würzburg, Würzburg, Germany
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