ENDOSCOPIC VACUUM THERAPY FOR TREATMENT OF THE ESOPHAGOJEJUNOSTOMOSIS LEAKEGE

The patient of 72 y.o. suffering from stomach cancer underwent gastrectomy with the formation of an esophagojejunostomy. The diagnosis of anastomosic failure was made on the 3^rd day after the operation. The endoscopic clipping of the fistula was ineffective. On the 7^th day after the operation, the anastomosis diverged by 2/3 of the circumference and the leakage in the mediastinum formed.

Additional mediastinal drainage was inserted laparoscopically. A fully covered self-expanding metal stent was placed. On the 3^rd day the deformation of the proximal part of the stent was identified and the renewal of the inflow of the contents by drainage was noted. Stenting via stent-in-stent technique was performed. In 2 months the treatment was not successful.

The next stage of treatment was an endoscopic placement of a vacuum aspiration system. On the gastric probe, a polypropylene sponge connected to vacuum aspiration with a vacuum of 100 mm Hg was inserted in the esophagus.

The sponge was exchanged every 3 – 4 days. There was a progressive decrease in cavity followed by a complete closure of the fistula on 19^th day. Within 2 months there were no signs of anastomosic stricture.