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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2020; 12(3): 104-115
Published online Mar 27, 2020. doi: 10.4240/wjgs.v12.i3.104
Acute esophageal necrosis: A systematic review and pooled analysis
Dimitrios Schizas, Nikoletta A Theochari, Konstantinos S Mylonas, Prodromos Kanavidis, Eleftherios Spartalis, Stamatina Triantafyllou, Konstantinos P Economopoulos, Dimitrios Theodorou, Theodore Liakakos
Dimitrios Schizas, Konstantinos S Mylonas, Prodromos Kanavidis, Theodore Liakakos, First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
Dimitrios Schizas, Nikoletta A Theochari, Konstantinos S Mylonas, Konstantinos P Economopoulos, Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece
Konstantinos S Mylonas, Eleftherios Spartalis, Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens 11527, Greece
Stamatina Triantafyllou, Dimitrios Theodorou, First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens 11527, Greece
Konstantinos P Economopoulos, Department of Surgery, Duke University Medical Center, Durham, NC 27708, United States
Author contributions: Schizas D, Liakakos T, and Theochari NA designed the research; Theochari NA, Kanavidis P, Schizas D, and Mylonas KS performed the research; Theochari NA, Schizas D, Kanavidis P, Mylonas KS, Spartalis E, Triantafyllou S, and Economopoulos KP analyzed and interpreted the data; Schizas D, Theochari NA, Mylonas KS, and Kanavidis P wrote the paper; Schizas D, Mylonas KS, Theodorou D, Liakakos T, and Theochari NA Economopoulos revised the manuscript for important intellectual content.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript. All the Authors have no conflict of interest related to the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nikoletta A Theochari, MD, Doctor, Department of Medicine, Surgery Working Group, Society of Junior Doctors, 29 Parnithos, 16344 Ilioupolis, Athens 15122, Greece.
nickyth12@gmail.com
Received: October 19, 2019
Peer-review started: October 19, 2019
First decision: November 19, 2019
Revised: December 2, 2019
Accepted: December 23, 2019
Article in press: December 23, 2019
Published online: March 27, 2020
Processing time: 131 Days and 19.9 Hours
BACKGROUND
Acute esophageal necrosis (AEN) is a rare entity with multifactorial etiology, usually presenting with signs of upper gastrointestinal bleeding.
AIM
To systematically review all available data on demographics, clinical features, outcomes and management of this medical condition.
METHODS
A systematic literature search was performed with respect to the PRISMA statement (end-of-search date: October 24, 2018). Data on the study design, interventions, participants and outcomes were extracted by two independent reviewers.
RESULTS
Seventy-nine studies were included in this review. Overall, 114 patients with AEN were identified, of whom 83 were males and 31 females. Mean patient age was 62.1 ± 16.1. The most common presenting symptoms were melena, hematemesis or other manifestations of gastric bleeding (85%). The lower esophagus was most commonly involved (92.9%). The most widely implemented treatment modality was conservative treatment (75.4%), while surgical or endoscopic intervention was required in 24.6% of the cases. Mean overall follow-up was 66.2 ± 101.8 d. Overall 29.9% of patients died either during the initial hospital stay or during the follow-up period. Gastrointestinal symptoms on presentation [Odds ratio 3.50 (1.09-11.30), P = 0.03] and need for surgical or endoscopic treatment [surgical: Odds ratio 1.25 (1.03-1.51), P = 0.02; endoscopic: Odds ratio 1.4 (1.17-1.66), P < 0.01] were associated with increased odds of complications. A sub-analysis separating early versus late cases (after 2006) revealed a significantly increased frequency of surgical or endoscopic intervention (9.7 % vs 30.1% respectively, P = 0.04)
CONCLUSION
AEN is a rare condition with controversial pathogenesis and unclear optimal management. Although the frequency of surgical and endoscopic intervention has increased in recent years, outcomes have remained the same. Therefore, further research work is needed to better understand how to best treat this potentially lethal disease.
Core tip: This manuscript’s aim was to systematically review and synthesize all available data on demographics, clinical features, outcomes and the management of acute esophageal necrosis. According to our results, acute esophageal necrosis is a rare condition with controversial pathogenesis and unclear optimal management. Although the frequency of surgical and endoscopic intervention has increased in recent years, outcomes have remained the same. Therefore, further investigations are needed to better understand how to best treat this potentially lethal disease.
