Endoscopic Vacuum Therapy as Treatment Option in Patients With Gastrointestinal Anastomotic Leakages

Aims Anastomotic leakage and associated mediastinitis and sepsis are serious complications after major abdominal interventions. The mortality rate in this group of patients measures up to 30 %. Nevertheless, traditional curative surgical interventions lead to an increase in mortality up to 64 %, which makes minimally invasive technologies beneficial.

The treatment strategy of a patient with anastomotic leakage aims to several problems solution: drainage and sanitation of the leakage cavity, nutritional support, closure of the perforation, prevention, and treatment of purulent complications.

Since 2006, a new method of endoscopic vacuum therapy in the management of anastomotic leaks has become available in clinical practice.

Methods From 2015 to 2020 years, anastomotic leakage was diagnosed in 12 patients. This involved 9 patients with esophagogastric anastomotic leakage and 3 patients with esophagojejunal leakage. The average age was 67.5 years. The size of anastomotic perforation ranged from 0.8 cm to 3 cm.

Vacuum therapy was used on the day of diagnosis of the leakage, except from the very first patient. In that case the therapy was applied on the 87th day after ineffective treatment. The patient underwent three sessions of endoscopic stenting combined with adequate drainage of the mediastinum.

Results 57 procedures were performed totally: the average number of replacements was 4 (1-7 times), the interval between procedures was 6 days (3-13 days), the duration of treatment was 13 days (1-66 days). 10 patients were treated successfully (75 %).

There were two lethal outcomes due to progressive multiple organ failure in comorbid patients.

Conclusions Our experience showed that endoscopic vacuum therapy as a successful and economically justified method of leakage treatment. Although it demands appropriate skills, the technique is comparatively simple and feasible.

Citation: Pyatakova A, Shishin K, Nedoluzhko I et al. OP100 ENDOSCOPIC VACUUM THERAPY AS TREATMENT OPTION IN PATIENTS WITH GASTROINTESTINAL ANASTOMOTIC LEAKAGES. Endoscopy 2021; 53: S43.

Publication History

Article published online:
19 March 2021