TY - JOUR
T1 - Acute Esophageal Necrosis
T2 - A Retrospective Cohort Study Highlighting the Mayo Clinic Experience
AU - Colón, Anthony Robateau
AU - Kamboj, Amrit K.
AU - Hagen, Catherine E.
AU - Rattan, Puru
AU - Coelho-Prabhu, Nayantara
AU - Buttar, Navtej S.
AU - Bruining, David H.
AU - Storm, Andrew C.
AU - Larson, Mark V.
AU - Viggiano, Thomas R.
AU - Wong Kee Song, Louis M.
AU - Wang, Kenneth K.
AU - Iyer, Prasad G.
AU - Katzka, David A.
AU - Leggett, Cadman L.
N1 - Funding Information:
Dr Bruining has received grants/contracts from Medtronic and grants/contracts and consulting fees from Janssen Pharmaceuticals , Inc; Dr Storm has been a consultant for Apollo Endosurgery, Inc, EnteraSense Ltd, Erbe Elektromedizin GmbH, GI Dynamics, and Olympus Corporation and has received research grants from Apollo Endosurgery, Inc, Boston Scientific Corporation , and endo-TAGSS, LLC; Dr Wong Kee Song has been a consultant for Olympus Corporation , Intuitive Surgical , Inc, and STERIS Corporation; Dr Wang has been a consultant and advisory board member for CSA Medical Inc and received research funding from CSA Medical Inc, Interscope, Inc, and Fujifilm Corporation; Dr Iyer has been a consultant for Simple Surgical Inc and Medtronic and has received research funding from Exact Sciences Corporation, Medtronic , and PENTAX Medical; Dr Katzka has been a consultant for Takeda Pharmaceutical Company Limited . The other authors report no competing interests.
Publisher Copyright:
© 2022 Mayo Foundation for Medical Education and Research
PY - 2022/10
Y1 - 2022/10
N2 - Objective: To describe the clinical, endoscopic, and histologic features in patients with acute esophageal necrosis (AEN). Patients and Methods: In this retrospective cohort study, patients who were diagnosed as having AEN at Mayo Clinic sites in Minnesota, Florida, and Arizona between January 1, 1996, and January 31, 2021, were included. Data were collected on patient clinical characteristics and endoscopic and pathologic findings. Results: The study included 79 patients with AEN with a median (range) age of 64 years (12 to 91 years); 53 (67.1%) were men. Predominant presenting symptoms were hematemesis (49 of 79 [62.0%]), abdominal pain (29 [36.7%]), and melena (20 [25.3%]). Shock was the triggering event for AEN in 49 (62.0%). The 30- and 90-day mortality were 24.0% (19 of 79) and 31.6% (25), respectively. The presence of coexisting infection or bacteremia was significantly associated with 90-day mortality (P<.01). Endoscopically, involvement of the distal third only, distal two-thirds only, and entire esophagus was observed in 31.6% (24 of 76), 39.5% (30), and 29.0% (22), respectively. The length of esophageal involvement correlated with duration of hospitalization (P=.05). The endoscopic appearance of the esophageal mucosa ranged from predominantly white (21 of 44 [47.7%]) to mixed white and black (13 [29.6%]) to predominantly black (10 [22.7%]), and sloughing was present in 18 (40.9%). In the 26 patients with histopathologic findings available for review, 25 (96.1%) had necrosis and/or ulceration with abundant pigmentation. Among the 79 patients, 39 (49.4%) had a follow-up esophagogastroduodenoscopy; 26 of these 39 patients (66.7%) had resolution while 5 had persistent AEN, 4 of whom had improvement. Esophageal strictures developed in 7 of the 39 patients (18.0%). Conclusion: Acute esophageal necrosis is a serious condition observed in critically ill patients. Its endoscopic appearance can be highly variable. In patients with an unclear diagnosis, esophageal biopsies may be helpful given the characteristic histologic findings.
AB - Objective: To describe the clinical, endoscopic, and histologic features in patients with acute esophageal necrosis (AEN). Patients and Methods: In this retrospective cohort study, patients who were diagnosed as having AEN at Mayo Clinic sites in Minnesota, Florida, and Arizona between January 1, 1996, and January 31, 2021, were included. Data were collected on patient clinical characteristics and endoscopic and pathologic findings. Results: The study included 79 patients with AEN with a median (range) age of 64 years (12 to 91 years); 53 (67.1%) were men. Predominant presenting symptoms were hematemesis (49 of 79 [62.0%]), abdominal pain (29 [36.7%]), and melena (20 [25.3%]). Shock was the triggering event for AEN in 49 (62.0%). The 30- and 90-day mortality were 24.0% (19 of 79) and 31.6% (25), respectively. The presence of coexisting infection or bacteremia was significantly associated with 90-day mortality (P<.01). Endoscopically, involvement of the distal third only, distal two-thirds only, and entire esophagus was observed in 31.6% (24 of 76), 39.5% (30), and 29.0% (22), respectively. The length of esophageal involvement correlated with duration of hospitalization (P=.05). The endoscopic appearance of the esophageal mucosa ranged from predominantly white (21 of 44 [47.7%]) to mixed white and black (13 [29.6%]) to predominantly black (10 [22.7%]), and sloughing was present in 18 (40.9%). In the 26 patients with histopathologic findings available for review, 25 (96.1%) had necrosis and/or ulceration with abundant pigmentation. Among the 79 patients, 39 (49.4%) had a follow-up esophagogastroduodenoscopy; 26 of these 39 patients (66.7%) had resolution while 5 had persistent AEN, 4 of whom had improvement. Esophageal strictures developed in 7 of the 39 patients (18.0%). Conclusion: Acute esophageal necrosis is a serious condition observed in critically ill patients. Its endoscopic appearance can be highly variable. In patients with an unclear diagnosis, esophageal biopsies may be helpful given the characteristic histologic findings.
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U2 - 10.1016/j.mayocp.2022.03.018
DO - 10.1016/j.mayocp.2022.03.018
M3 - Article
C2 - 35779957
AN - SCOPUS:85133380143
SN - 0025-6196
VL - 97
SP - 1849
EP - 1860
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 10
ER -