ENDOSCOPIC VACUUM THERAPY FOR PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGO-GASTRIC SURGERY

Aims Anastomotic leakage (AL) after upper gastro-intestinal (UGI) surgery is associated with severe morbidity and mortality. Recently, endoscopic vacuum therapy (EVT) was introduced as treatment of AL. The aim of this study was to describe outcomes of initial experiences with EVT in a tertiary referral center in AL treatment after esophago-gastric surgery.

Methods For this retrospective cohort study, all patients treated with EVT for AL in the UGI tract at a tertiary referral center, between January 2018 and October 2021, were included. This period, patients with AL were primarily treated with EVT. Data on patient characteristics, EVT and outcomes were analyzed. The primary endpoint was success rate of EVT alone, defined as closure of the defect assessed by endoscopy or CT-scan.

Results: 38 patients were included (31 men, mean age 66 yrs (SD 9.3)) (Table 1). Successful treatment was achieved in 28 patients (74%). In 10 patients EVT failed: one deceased during treatment (radiation pneumonitis) and 9 underwent additional surgery.

Median hospital stay was 42 days, median duration of EVT was 27 days, with median 6 EVT-related endoscopies and 5 days between sponge exchanges. 22 patients (58%) received additional drainage. EVT associated complications occurred in two patients (5%): in one patient the overtube caused iatrogenic defect expansion and one developed a tracheo-esophageal fistula.

Table 1 Baseline characteristics.

Total number of patients, n Male Female	38 31 7
Age in years, mean (range, SD)	66.3 (37-78, 9.3)
Neoadjuvant/perioperative therapy, n None Chemoradiotherapy Chemotherapy	37 6 26 5
Operation technique, n Ivor Lewis McKeown Salvage esophagectomy Total gastrectomy with distal esophagectomy Total gastrectomy	37 22 5 1 2 7
Anastomosis, n Esophago-jejunal Esophago-gastric Intrathoracic Cervical	38 12 26 21 5

Conclusions EVT is a paradigm shifting treatment potentially preventing surgical re-intervention in patients with AL after UGI surgery, with a 74% success rate. More experience with the technique and indications for use will likely improve success rates.

Publication History

Article published online:
14 April 2022