Endoscopic filling with polyglycolic acid sheets and fibrin glue of persistent fistula after esophagectomy

Abstract

Background Treatment of anastomotic leakage in reconstruction after esophagectomy remains challenging. This report presents a new endoscopic filling method for persistent fistula after failure of conservative treatment of leakage caused by anastomotic insufficiency.

Methods 10 of 14 patients, in whom post-esophagectomy leakage had failed to resolve after 2 weeks of conservative treatment, underwent endoscopic filling with polyglycolic acid (PGA) sheet and fibrin glue into the anastomotic leakage site, using a delivery tube and endoscopic catheter, respectively.

Results Each patient underwent jejunostomy, to secure nutrition. The leakage was resolved in all 10 patients. The mean number of PGA – fibrin glue procedures was 1.7. The mean period from the first application to the resumption of oral intake was 31.6 days, from the final application it was 14.7 days.

Conclusions The reported filling method offers a new endoscopic approach for persistent fistula after esophagectomy when conservative treatment of leakage has failed.

^* These authors contributed equally to this article as first authors.

Publication History

Received: 15 January 2020

Accepted: 16 June 2020

Accepted Manuscript online:
16 June 2020

Article published online:
08 October 2020

• References

• 1 Kassis ES, Kosinski AS, Ross PJr. et al. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg 2013; 96: 1919-1926
• 2 Biere SS, Maas KW, Cuesta MA. et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg 2011; 28: 29-35
• 3 Sauvanet A, Mariette C, Thomas P. et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 2005; 201: 253-262
• 4 Sunpaweravong S, Ruangsin S, Laohawiriyakamol S. et al. Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients. Asian J Surg 2012; 35: 104-109
• 5 Haga Y, Wada Y, Takeuchi H. et al. Prediction of anastomotic leak and its prognosis in digestive surgery. World J Surg 2011; 35: 716-722
• 6 Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004; 10: 71-75
• 7 Takemura M, Yoshida K, Fujiwara Y. et al. Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc 2013; 27: 1249-1253
• 8 Nakano Y, Takao T, Morita Y. et al. Endoscopic plombage with polyglycolic acid sheets and fibrin glue for gastrointestinal fistulas. Surg Endosc 2019; 33: 1795-1801
• 9 Terasaka S, Iwasaki Y, Shinya N. et al. Fibrin glue and polyglycolic acid nonwoven fabric as a biocompatible dural substitute. Neurosurgery 2006; 58 : ONS134-139
• 10 Yamana I, Takeno S, Yamada T. et al. The risk factors for refractory fistula after esophagectomy with gastric tube reconstruction in patients with esophageal cancer. Dig Surg 2017; 34: 18-24
• 11 Kosumi K, Baba Y, Ozaki N. et al. Transnasal inner drainage: an option for managing anastomotic leakage after esophagectomy. Langenbecks Arch Surg 2016; 401: 903-908
• 12 Truong S, Böhm G, Klinge U. et al. Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue. Surg Endosc 2004; 18: 1105-1108