Acute esophageal necrosis: A 1-year prospective study

doi:10.1016/S0016-5107(02)70180-6

Gastrointestinal Endoscopy

Volume 56, Issue 2, August 2002, Pages 213-217

Presented in part at the Digestive Disease Week, May 20-23, 2001, Atlanta, Georgia (Gastrointest Endosc 2001;53:AB152).

https://doi.org/10.1016/S0016-5107(02)70180-6 Get rights and content

Abstract

Background: A prospective 1-year study was conducted to assess the frequency, clinical spectrum, histologic description, and follow-up of acute esophageal necrosis unrelated to ingestion of caustic or corrosive agents. Methods: The diagnosis of acute esophageal necrosis was based on a diffusely black esophagus at endoscopy and typical histologic features of diffuse mucosal and submucosal necrosis. Ingestion of caustic and corrosive agents was excluded in all patients. Medical history, associated diseases, and clinical symptoms were recorded for each patient. Nutritional status was evaluated based on clinical and biochemical parameters. Treatment included short-term parenteral nutrition and intravenous administration of a pump proton inhibitor. A second endoscopy was performed when possible at 2 weeks after presentation to assess regression of acute esophageal necrosis. Results: Among 3900 patients who underwent EGD, 8 (0.2%) with acute esophageal necrosis were identified. Nutritional status was poor for 6 patients. Complete resolution of acute esophageal necrosis without further recurrence was observed in 4. No esophageal strictures appeared during follow-up. Four patients died, but no death was directly related to acute esophageal necrosis. Conclusion: Acute esophageal necrosis is not as infrequent an endoscopic finding as has been reported. Acute esophageal necrosis appears to be associated with poor general health status and is not a purely local phenomenon. (Gastrointest Endosc 2002;56:213-7.)

Section snippets

Patients and methods

A prospective study was conducted from October 1999 to September 2000 by the endoscopic team of the gastroenterology department that performs all endoscopic examinations at our hospital. Upper endoscopy was performed with a videoendoscope (GIF; Olympus Optical Co., Ltd., Tokyo, Japan). The study was approved by our local ethics committee, and informed consent was obtained from all patients unless an emergency situation made this impossible.

Criteria for the diagnosis of AEN included the presence

Results

Of 3900 patients who underwent EGD during the study period, 8 patients (mean age 67.6 years; range 21-89 years) (0.2%) had AEN; 7 were men. Upper endoscopy demonstrated AEN as a diffusely black esophagus, sometimes with adherent yellow exudate. Necrosis was usually present in the distal third of the esophagus but sometimes involved the entire esophagus. Presenting symptoms are summarized in Table 1, the most common being acute esophageal bleeding. Symptoms caused by AEN were the reason for

Discussion

The main result of the present study is that AEN was found in 0.2% of the 3900 patients who underwent endoscopy at a university hospital during a specified period of time. This frequency is higher than the 0.0125% reported by Moreto et al.⁷ Based on experience over 2 decades, Lacy et al.² estimated that the incidence of AEN was less than 0.01%. Data from autopsy studies are also conflicting: the frequency ranges from 0.2%⁸, as in the present study, to zero.⁹ Although AEN is a rare entity, its

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^☆: Reprint requests: Guillaume Savoye, MD, Digestive Disease Research Tract, Department of Hepatogastroenterology, Rouen University Hospital C. Nicolle, 1 rue de Germont, 76031 Rouen Cedex France.

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Original ArticlesAcute esophageal necrosis: A 1-year prospective study☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Gastroenterology

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

J Thor Cardiovasc Surg

Gastroenterology

Gastrointest Endosc

Ann Thorac Surg

Original Articles
Acute esophageal necrosis: A 1-year prospective study☆