Anthony W. Robateau, MD, Amrit K. Kamboj, MD, Catherine Hagen, MD, Kenneth Wang, MD, Prasad G. Iyer, MD, MSc, FACG, David A. Katzka, MD, Puru Rattan, MD, Cadman Leggett, MD Mayo Clinic, Rochester, MN
Introduction: Acute esophageal necrosis (AEN) is a poorly understood disease. We report the largest retrospective review of patients with AEN and describe the clinical presentation and outcomes.
Methods: Single center, multisite, retrospective cohort study. Patients included were diagnosed with AEN between 1996 and 2021 and were identified using a keyword search of all available clinical documentation and confirmed via manual chart review. Data was collected on patient demographics, comorbidities, symptoms, endoscopic and histologic findings. The student t-test was used to analyze continuous variables for association with 30-day mortality and with extent of esophageal involvement.
Results: Our search identified 79 patients with AEN {median age of 64 (12-91) years; 67% male}. Comorbidities included hypertension (68%), dyslipidemia (61%), gastroesophageal reflux disease (41%), coronary artery disease (39%), and diabetes mellitus (35.4%). Current or former smoking and alcohol use was present in 60% and 67%, resp. Predominant symptoms were hematemesis (62%), abdominal pain (37%), and melena (25%). Shock was the triggering event for AEN in 62% of patients. The 30- and 90-day mortality was 24% and 32%, resp. The presence of systemic infection was significantly associated with death at 30 days (p=0.03). Endoscopic findings showed involvement of the distal third of the esophagus in 31.6%, distal two-thirds of the esophagus in 39.5%, and panesophageal in 28.9%. The length of hospitalization correlated with greater esophageal involvement (p=0.05). The endoscopic appearance of AEN ranged from diffuse white appearance to black mucosa (Figure A & B). More than half (54%) showed concomitant duodenal pathology. In biopsies from 26 patients nearly all (96%) showed necrosis and/or ulceration on pathology (Figure C & D). 39 patients (49%) had a follow-up EGD with median (range) time of 35 (1-43,305) days. Twenty-six (67%) patients had resolution of AEN. Persistent AEN was seen in 5 patients with 4 showing gradual improvement. 7 (18%) patients developed esophageal strictures.
Discussion: AEN should be suspected in patients with multiple comorbidities presenting with upper gastrointestinal bleeding or abdominal pain in the setting of shock. Endoscopic appearance can be variable. AEN is associated with significant morbidity and mortality, but in those that survive, AEN resolves over time but with stricture formation in some.
Figure: Figure A : Diffuse white appearance of AEN Figure B : Diffuse, predominantly black appearance of AEN Figure C & D: Histopathologic appearance of AEN, showing area of necrosis with brown/black necrotic debris ( arrow)
Disclosures: Anthony Robateau indicated no relevant financial relationships. Amrit Kamboj indicated no relevant financial relationships. Catherine Hagen indicated no relevant financial relationships. Kenneth Wang: Endorotor – Other Financial or Material Support, Research support. Fuji Medical – Other Financial or Material Support, Research support. PCI – Other Financial or Material Support, Research support. Pentax Medical – Other Financial or Material Support, Research support. Prasad Iyer indicated no relevant financial relationships. David Katzka: Celgene – Consultant, Grant/Research Support. Takeda – Consultant, Grant/Research Support. Puru Rattan indicated no relevant financial relationships. Cadman Leggett indicated no relevant financial relationships.
Anthony W. Robateau, MD, Amrit K. Kamboj, MD, Catherine Hagen, MD, Kenneth Wang, MD, Prasad G. Iyer, MD, MSc, FACG, David A. Katzka, MD, Puru Rattan, MD, Cadman Leggett, MD. P1353 - Acute Esophageal Necrosis: A Retrospective Cohort Study Highlighting a Single Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
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