Combined EVT and SEMS Endoscopic Treatment of Upper Gastrointestinal Anastomotic Leaks in Oncological Patients: Efficacy and Safety Analysis at a Tertiary Referral Center

Aims Anastomotic leak (AL) is a potentially life-threatening complication of esophagectomy and gastrectomy [1]. Endoscopic vacuum therapy (EVT, such as EsoSponge or VacStent-GI™) and self-expandable metal stents (SEMS) represent promising endoscopic treatment options for AL, with no conclusive evidence on the best approach in oncologic patients [2]. We aimed to assess the efficacy and safety of combined EVT and SEMS treatment of upper gastrointestinal AL in oncologic patients at our tertiary referral center.

Methods We analyzed data from consecutive patients who underwent endoscopic treatment for AL post-esophagectomy and/or gastrectomy due to malignancy, from January 2018 to October 2024. Clinical success was defined as complete endoscopic closure of the AL. Patient demographics, AL characteristics, treatment type, treatment duration, and complications were documented.

Results The study cohort included 40 patients (mean age 70 years; 30 male), 24 patients received prior neoadjuvant therapy. A total of 40 ALs were treated, with a median leak size of 8 mm (IQR 5-21 mm); 24 patients had para-anastomotic fluid collections (median size 53 mm; IQR 31–72 mm). Leaks location included esophagogastric anastomosis (n=15), esophagojejunal anastomosis (n=23) and esophagocolic anastomosis (n=2). Stent placement (either partially covered SEMS or VacStent-GI™) was used as initial treatment in 24 cases, either alone or with concomitant percutaneous drainage (n=10) and resulted in a clinical success rate of 75% (18/24) after a mean of 38 days (21-73 days). An average of 1.4 stents per patient were used. In 16 cases EsoSponge was used prior to stent placement, with a mean duration of treatment of 10 days (1-26 days) and a mean number of 3 devices per patient. Overall clinical success rate, after stent placement, was 75% (12/16) after a mean of 36 days (6-61 days). An average of 1.5 stents per patient were used. We observed 8 mild adverse events: 2 cases of stent migration, 2 post-stent strictures, 2 instances of mild bleeding after stent removal, 1 early removal due to intolerance, and 1 fully embedded stent. No severe adverse device event (SADE) was observed.

Conclusions In our experience, a combined use of EVT and esophageal stents is a safe and effective approach for managing complex upper gastrointestinal ALs in high-risk oncologic patients. We observed a high rate of clinical success with a manageable rate of mild adverse events and no SADE observed.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Mandarino FV, Barchi A, D'Amico F, Fanti L, Azzolini F, Viale E, Esposito D, Rosati R, Fiorino G, Bemelman WA, Elmore U, Barbieri L, Puccetti F, Testoni SGG, Danese S.. Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis. Life (Basel) 2023; 13 (2): 287 PMID: 36836644; PMCID: PMC9968149
• 2 Fabbi M, Hagens EC, van Berge Henegouwen MI, Gisbertz SS. Anastomotic leakage after esophagectomy for esophageal cancer: definitions, diagnostics, and treatment. Diseases of the Esophagus 2021; 34 (Issue 1): doaa039