{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T20:45:45Z","timestamp":1785703545712,"version":"3.56.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Esophageal perforation is a time-critical emergency in which delayed diagnosis is associated with substantial morbidity and mortality. Fluoroscopic esophagography (FE) and computed tomography esophagram (CTE) are commonly used, but their optimal roles in the acute diagnostic pathway remain uncertain. We performed a systematic review and meta-analysis comparing the diagnostic performance of FE and CTE in adults with suspected esophageal perforation and clarifying their complementary utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>PubMed, Embase, and Cochrane Library were searched from inception to October 26, 2025, for observational studies evaluating both FE and CTE in adults with suspected esophageal perforation and providing data for 2 \u00d7 2 contingency tables. Pooled diagnostic estimates were calculated using univariate and bivariate random-effects models. Direct comparisons were performed using Z tests on transformed summary estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four retrospective studies including 439 patients met inclusion criteria; 69 patients (15.6%) had confirmed perforation. FE showed pooled sensitivity of 69.2% (95% CI, 48.9-84.0) and specificity of 98.4% (95% CI, 96.3-99.4). CTE showed higher sensitivity (81.8%; 95% CI, 38.5-97.0) but lower specificity (86.7%; 95% CI, 67.3-95.4). Sensitivity and specificity did not differ significantly between modalities. However, FE had significantly higher PPV, PLR, and AUC than CTE, indicating stronger rule-in and overall discriminative performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CTE and FE should be considered complementary tests. CTE is well suited for initial evaluation because of its sensitivity and broader anatomic assessment, whereas FE provides stronger confirmatory value, supporting a sequential strategy of initial CTE followed by selective FE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261472868","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:58:59Z","timestamp":1785387539000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["CT for Detection, Fluoroscopy for Confirmation: A Meta-Analysis of Imaging in Suspected Esophageal Perforation"],"prefix":"10.1177","author":[{"given":"Rachid Eduardo Noleto","family":"da Nobrega Oliveira","sequence":"first","affiliation":[{"name":"Barretos Cancer Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7687-3073","authenticated-orcid":false,"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidade Federal de Minas Gerais"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Braga","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidade Federal de Uberl\u00e2ndia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Castello Branco","family":"Bastos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidade Federal de S\u00e3o Jo\u00e3o del Rei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe S.","family":"Passos","sequence":"additional","affiliation":[{"name":"MaterDei Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Faria","sequence":"additional","affiliation":[{"name":"UTMB John Sealy School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Petrov","sequence":"additional","affiliation":[{"name":"UTMB John Sealy School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-022-05454-2"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-025-05142-0"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.0088"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-025-12090-9"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/MOG.0000000000001095"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2024.116061"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-019-02187-w"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.21037\/shc.2020.02.02"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-019-0245-2"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.14744\/tjtes.2024.26020"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMicm2310882"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1067\/j.cpradiol.2025.10.010"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.3348\/kjr.2025.0118"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.70158"},{"key":"e_1_3_4_16_2","doi-asserted-by":"crossref","unstructured":"Wohlin C. Guidelines for snowballing in systematic literature studies and a replication in software engineering. In Proceedings of the 18th International Conference on Evaluation and Assessment in Software Engineering (EASE \u203214). 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Report of a case of treatment for unresectable esophageal cancer with esophageal perforation and lung abscess. Gan To Kagaku Ryoho. 2025;52:1395-1397. PMID: 41546360."},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-025-02339-0"},{"key":"e_1_3_4_32_2","volume-title":"Esophageal Ulcer. StatPearls, Treasure Island (FL)","author":"Nguyen C","year":"2026","unstructured":"Nguyen C, Tian C, Samant H. Esophageal Ulcer. StatPearls, Treasure Island (FL). 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