Endoscopic Management of Anastomotic Leakage after Esophageal Surgery: Ten Year Analysis in a Tertiary University Center
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Background/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade,management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, thetreatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized. Methods: Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were includedin this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed. Results: Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS)four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closurein 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stablepatients with small defect sizes. Conclusions: EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should belimited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.
Abstract
Background/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade,management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, thetreatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized. Methods: Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were includedin this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed. Results: Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS)four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closurein 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stablepatients with small defect sizes. Conclusions: EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should belimited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.
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