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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
ARTICLE HIGHLIGHTS
Research background
Acute esophageal necrosis (AEN) is a severe medical condition with multifactorial etiology. Our experience is mainly based on case reports and small case series.
Research motivation
Given the rarity of this entity, further investigations are needed to better understand the risk factors, pathogenesis, diagnostic challenges and how to best treat this potentially lethal disease.
Research objectives
Our objective was to investigate all available data on demographics, clinical features, outcomes of this condition and to suggest the best management.
Research methods
We performed a systematic literature search with respect to the PRISMA statement. Univariate logistic regression was performed with logit transformation of data.
Research results
Overall, 114 patients with AEN were included in this study. The most common symptoms on admission were melena, hematemesis or other manifestations of gastric bleeding. With regards to treatment modalities, conservative treatment was the most widely implemented choice followed by surgical or/and endoscopic intervention. A sub-analysis separating early versus late cases (after 2006) revealed a significantly increased frequency of surgical or endoscopic intervention. Nevertheless, further research work is needed to better understand how to best treat this potentially deadly disease.
Research conclusions
To the best of our knowledge, this is the most up to date and comprehensive systematic review regarding AEN. This rare entity seems to have multi-factorial etiology, but ischemia seems to play the most significant role in pathogenesis. Diagnosis is made by upper gastrointestinal endoscopy, while conservative treatment seems to be still the most popular modality. Nevertheless, our study revealed that operative interventions have increased the last years. Black esophagus is a medical condition that is still difficult recognized. To that end, a staging system that classifies the patients with AEN according to their symptoms on admission, their medical history and the endoscopic findings would be meaningful.
Research perspectives
Further investigations are needed to better understand the risk factors, pathogenesis, diagnostic challenges and optimum treatment approach for this rare but potentially lethal condition.
