Endoscopic internal drainage and low negative-pressure endoscopic vacuum therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Abstract

Background Endoscopic internal drainage (EID) with double-pigtail stents or low negative-pressure endoscopic vacuum therapy (EVT) are treatment options for leakage after upper gastrointestinal oncologic surgery. We aimed to compare the effectiveness of these techniques.

Methods Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtail stents were changed every 4 weeks; EVT was repeated every 3–4 days until leak closure.

Results 35 EID and 27 EVT patients were included, with a median (interquartile range [IQR]) leak size of 0.75 cm (0.5–1.5). Overall treatment success was 100 % (95 % confidence interval [CI] 90 %–100 %) for EID vs. 85.2 % (95 %CI 66.3 %–95.8 %) for EVT (P = 0.03). The median (IQR) number of endoscopic procedures was 2 (2–3) vs. 3 (2–6.5; P = 0.003) and the median (IQR) treatment duration was 42 days (28–60) vs. 17 days (7.5–28; P < 0.001), for EID vs. EVT, respectively.

Conclusion EID and EVT provide high closure rates for upper gastrointestinal anastomotic leaks. EVT provides a shorter treatment duration, at the cost of a higher number of procedures.

• References

• 1 Rutegard M, Lagergren P, Rouvelas I. et al. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol 2012; 19: 99-103
• 2 Rutegard M, Lagergren P, Rouvelas I. et al. Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. Eur J Surg Oncol 2012; 38: 555-561
• 3 Blencowe NS, Strong S, McNair AG. et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg 2012; 255: 658-666
• 4 Watanabe M, Miyata H, Gotoh M. et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 2014; 260: 1034-1039
• 5 Rodrigues-Pinto E, Morais R, Macedo G. et al. Choosing the appropriate endoscopic armamentarium for treatment of anastomotic leaks. Am J Gastroenterol 2019; 114: 367-371
• 6 Jung CFM, Muller-Dornieden A, Gaedcke J. et al. Impact of endoscopic vacuum therapy with low negative pressure for esophageal perforations and postoperative anastomotic esophageal leaks. Digestion 2020;
• 7 Pequignot A, Fuks D, Verhaeghe P. et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy?. Obes Surg 2012; 22: 712-720
• 8 Donatelli G, Dumont JL, Cereatti F. et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 2015; 25: 1293-1301
• 9 Donatelli G, Dumont JL, Cereatti F. et al. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series. Endosc Int Open 2016; 4: E647-E651
• 10 Loske G, Muller CT. Tips and tricks for endoscopic negative pressure therapy. Chirurg 2019; 90: 7-14
• 11 Wedi E, Schuler P, Kunsch S. et al. Individual endoscopic management of anastomotic insufficiency after esophagectomy for esophageal squamous cell carcinoma and creation of a neostomach. Endoscopy 2018; 50: E69-E71
• 12 Bouchard S, Eisendrath P, Toussaint E. et al. Trans-fistulary endoscopic drainage for post-bariatric abdominal collections communicating with the upper gastrointestinal tract. Endoscopy 2016; 48: 809-816