TY - JOUR
TI - Acute esophageal necrosis: A systematic review and pooled analysis
AU - Schizas, Dimitrios
AU - Theochari, Nikoletta A.
AU - Mylonas, Konstantinos
AU - S.
AU - Kanavidis, Prodromos
AU - Spartalis, Eleftherios and
AU - Triantafyllou, Stamatina
AU - Economopoulos, Konstantinos P. and
AU - Theodorou, Dimitrios
AU - Liakakos, Theodore
JO - WORLD JOURNAL OF GASTROINTESTINAL SURGERY
PY - 2020
VL - 12
TODO - 3
SP - 104-115
PB - BAISHIDENG PUBLISHING GROUP INC
SN - null
TODO - 10.4240/wjgs.v12.i3.104
TODO - Acute esophageal necrosis; Black esophagus; Acute necrotizing
esophagitis
TODO - 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.
ER -