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August 9, 1965


JAMA. 1965;193(6):537. doi:10.1001/jama.1965.03090060127014

Perforation of the esophagus as a complication of endoscopy is frequently treated by thoracotomy and closure of the perforation.1,2 However, a communication in the August issue of the Archives of Surgery indicates that lower morbidity and mortality may be achieved nonoperatively, placing reliance on intensive antibiotic therapy.3 In a series of 21 patients treated conservatively, one death is recorded. The mortality of 5% is lower than that found in similar series of patients treated surgically. The majority of the patients were discharged within two weeks of perforation, and neither chronic emphysema nor late-developing mediastinal abscess were found in the series.

Antibiotics are the primary agents in conservative management. Ten million units of penicillin intravenously and 1 gm of streptomycin intramuscularly per day are given upon diagnosis of the perforation. The patients are given nothing by mouth; their nutrition is maintained intravenously, and nasogastric suction is used in all

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