1e:T426,

Introduction

SINCE the impetus given endoscopy by Chevalier Jackson in the early years of this century, esophagoscopy has remained a valuable adjunct to the diagnosis and treatment of esophageal disease. Perforation of this thin-walled organ has, however, remained a constant source of worry to the endoscopist. Until 1940, perforation of the esophagus was accompanied by an appalling mortality rate. Subsequently it became recognized that early surgical intervention with closure of the perforation dramatically reduced this mortality rate. The present study gives our experience with nonoperative treatment of esophageal perforation resulting from endoscopy and highlights the impact of antibiotics on this dread complication. In 1948, Jemerin,¹in analyzing esophageal perforations of diverse etiologies, reported a mortality rate of 69% in patients treated non-operatively. He was able to reduce this mortality rate dramatically with the introduction of early drainage of the mediastinum and closure of the perforation, or both. Most large1f:T41e,THE HAZARDS of spontaneous perforation of the esophagus are such that 16 years after the first successful primary closure,¹the mortality rate varies between 34% and 50%.²In addition, the morbidity is considerable, and, while mediastinal drainage is readily accomplished and often life-saving, primary closure of the inflamed esophageal wall is commonly followed by suture-line breakdown and empyema. Recently Tuttle and Barrett,³reporting on four patients with spontaneous perforation of the distal esophagus, all of whom experienced sutureline breakdown when primary closure was attempted. The term Mallory-Weiss syndrome has been used to embrace both mucosal ulceration of the gastroesophageal junction with hemorrhage, and spontaneous perforation of the esophagus. It is true that both probably represent variants of the same disease. However, the former lesion was originally described by Mallory and Weiss, and the latter was described in the 18th century by Boerhaave. Moreover, complete perforation requires urgent

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