ENDOSCOPIC VACUUM THERAPY FOR COMPLEX CHRONIC POSTOPERATIVE ESOPHAGEAL LEAKS

Aims Anastomotic leak is a serious complication of esophagectomy. Endoscopic vacuum-assisted closure(EVAC) is a promising therapy, but its role in chronic leaks is not well established.We describe the case of a patient with refractory multiple esophageal leaks.

Methods A 62-year-old male with a large(7x7x5cm) symptomatic epiphrenic diverticulum underwent surgical diverticulectomy and distal oesophagus myotomy (December/2019). Due to oesophageal leak with empyema, he was re-intervened twice (leak closure, lateral oesophagostomy, oesophagus stappling plus jejunostomy), without success. Endoscopic evaluation revealed a 3mm leak, not amenable to clip closure.Esophageal stent placement was proposed, but refused. After 79 days, he was discharged with a patent small leak orifice, under antibiotics and exclusive jejunal feeding.After one year of recurrent pulmonary infections and spontaneous thoracic drainage everytime he tried to resume oral feeding, EVAC was proposed. The patient was referred to our unit and underwent endoscopic evaluation, showing a dilated, tortuous esophagus with five patent fistula openings with pale, well-defined borders. EVAC was started and the sponge was switched every two days.

Results After 29 days/12 sponges, 3 of the fistula opoenings were closed. There were no adverse events. Clip closure was attempted and the patient was discharged with monthly re-evaluation. After 1 month, only one orifice remained, despite the patient’s non-adherence to nil per os.

Conclusions In a refractory chronic case, EVAC allowed closure of 4/5 fistula openings. Therefore, it seems a safe alternative to consider even in late post-surgical esophageal leaks not amenable to stent placement or surgical correction.

Publication History

Article published online:
14 April 2022