A systematic review of transesophageal echocardiography (TEE)-induced esophageal perforation was done using the MEDLINE (PubMed and OVID interfaces), Google Scholar and EMBASE databases. Thirty-five cases of esophageal perforation from 22 studies were analyzed. TEE-induced esophageal perforation occurs in elderly female patients, predominantly in an intra-operative setting. Thoracic esophagus is the most commonly involved segment, especially, when TEE is performed intra-operatively. Majority of the esophageal perforations occur in cases with a perceived low risk or smooth TEE exam and thus, screening for high risk factors may not eliminate the occurrence of a perforation. A delayed detection of perforation occurs when it is a thoracic esophageal perforation, performed intra-operatively and when there are no known preoperative risk factors. Shock during the detection of the perforation is associated with mortality. Majority of the perforations can be repaired primarily.
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