Success of endoscopic vacuum therapy for persistent anastomotic leak after esophagectomy – a case report

Summary The curative treatment for esophageal and gastric cancer is primarily surgical resection. One of the main complications related to esophagogastric surgery is the anastomotic leak. This complication is associated with a prolonged length of stay, reduced quality of life, high treatment costs, and an increased mortality rate. The placement of endoluminal stents is the most frequent endoscopic therapy in these cases. However, since its introduction, endoscopic vacuum therapy has been shown to be a promising alternative in the management of this complication. This study primarily aims to evaluate the efficacy and safety of endoscopic vacuum therapy for the treatment of anastomotic leak in esophagectomy and total gastrectomy. A systematic review and meta-analysis was performed. Studies that evaluated the use of endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy were included. Twenty-three articles were included. A total of 559 patients were evaluated. Endoscopic vacuum therapy showed a fistulous orifice closure rate of 81.6% (rate: 0.816; 95% CI: 0.777–0.864) and, when compared to the stent, there is a 16% difference in favor of endoscopic vacuum therapy (risk difference [RD]: 0.16; 95% CI: 0.05–0.27). The risk for mortality in the endoscopic vacuum therapy was 10% lower than in endoluminal stent therapy (RD: −0.10; 95% CI: −0.18 to −0.02). Endoscopic vacuum therapy might have a higher rate of fistulous orifice closure and a lower rate of mortality, compared to intraluminal stenting.

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Modified Endoscopic Vacuum Therapy for Nonhealing Esophageal Anastomotic Leak: Technique Description and Review of Literature

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2017.0318 ◽

2018 ◽

Vol 28 (1) ◽

pp. 33-40 ◽

Cited By ~ 8

Author(s):

Guy Pines ◽

Ilan Bar ◽

Amir Elami ◽

Shimon Sapojnikov ◽

Ofir Hikri ◽

...

Keyword(s):

Anastomotic Leak ◽

Vacuum Therapy ◽

Review Of Literature ◽

Endoscopic Vacuum Therapy

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Effectiveness of endoscopic vacuum therapy as rescue treatment in refractory leaks after gastro-esophageal surgery

Updates in Surgery ◽

10.1007/s13304-020-00935-y ◽

2020 ◽

Author(s):

Carlo Alberto De Pasqual ◽

Valentina Mengardo ◽

Francesco Tomba ◽

Alessandro Veltri ◽

Michele Sacco ◽

...

Keyword(s):

Anastomotic Leak ◽

Healing Time ◽

Complete Healing ◽

Esophageal Surgery ◽

Vacuum Therapy ◽

Secondary Treatment ◽

Related Complication ◽

Vac Therapy ◽

Rescue Treatment ◽

Endoscopic Vacuum Therapy

AbstractThe treatment of leak after esophageal and gastric surgery is a major challenge. Over the last few years, endoscopic vacuum therapy (E-VAC) has gained popularity in the management of this life-threatening complication. We reported our initial experience on E-VAC therapy as rescue treatment in refractory anastomotic leak and perforation after gastro-esophageal surgery. From September 2017 to December 2019, a total of 8 E-VAC therapies were placed as secondary treatment in 7 patients. Six for anastomotic leak (3 cervical, 1 thoracic, 2 abdominal) and 1 for perforation of the gastric conduit. In 6 cases, E-VAC was placed intracavitary; while in the remaining 2, the sponge was positioned intraluminal (one patient was treated with both approaches). A total of 60 sponges were used in the whole cohort. The median number of sponge insertions was 10 (range: 5–14) with a median treatment duration of 41 days (range: 19–49). A complete healing was achieved in 4 intracavitary (67%) and in 1 intraluminal (50%) E-VAC. We observed only one E-VAC-related complication: a bleeding successfully managed endoscopically. E-VAC therapy seems to be a safe and effective tool in the management of leaks and perforations after upper GI surgery, although with longer healing time when it is used as secondary treatment.

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P.05.52 SUCCESSFUL CLOSURE OF ESOPHAGO-JEJUNAL ANASTOMOTIC LEAKAGE BY ENDOSCOPIC VACUUM THERAPY (EVT) WITH ESO-SPONGE SYSTEM: A CASE REPORT

Digestive and Liver Disease ◽

10.1016/s1590-8658(19)30413-x ◽

2019 ◽

Vol 51 ◽

pp. e205-e206

Author(s):

F. De Grazia ◽

M. Bardone ◽

L. Rovedatti ◽

S. Cococcia ◽

S. Agazzi ◽

...

Keyword(s):

Case Report ◽

Anastomotic Leakage ◽

Vacuum Therapy ◽

System A ◽

Endoscopic Vacuum Therapy

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Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Trials ◽

10.1186/s13063-021-05315-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Michael Tachezy ◽

Seung-Hun Chon ◽

Isabel Rieck ◽

Marcus Kantowski ◽

Hildegard Christ ◽

...

Keyword(s):

Quality Of Life ◽

Anastomotic Leak ◽

Vacuum Therapy ◽

Phase 2 ◽

Anastomotic Leaks ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Endoscopic Vacuum Therapy ◽

Eortc Qlq

Abstract Background Intrathoracic anastomotic leaks represent a major complication after Ivor Lewis esophagectomy. There are two promising endoscopic treatment strategies in the case of leaks: the placement of self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT). Up to date, there is no prospective data concerning the optimal endoscopic treatment strategy. This is a protocol description for the ESOLEAK trial, which is a first small phase 2 randomized trial evaluating the quality of life after treatment of anastomotic leaks by either SEMS placement or EVT. Methods This phase 2 randomized trial will be conducted at two German tertiary medical centers and include a total of 40 patients within 2 years. Adult patients with histologically confirmed esophageal cancer, who have undergone Ivor Lewis esophagectomy and show an esophagogastric anastomotic leak on endoscopy or present with typical clinical signs linked to an anastomotic leak, will be included in our study taking into consideration the exclusion criteria. After endoscopic verification of the anastomotic leak, patients will be randomized in a 1:1 ratio into two treatment groups. The intervention group will receive EVT whereas the control group will be treated with SEMS. The primary endpoint of this study is the subjective quality of life assessed by the patient using a systematic and validated questionnaire (EORTC QLQ C30, EORTC QLQ-OES18 questionnaire). Important secondary endpoints are healing rate, period of hospitalization, treatment-related complications, and overall mortality. Discussion The latest meta-analysis comparing implantation of SEMS with EVT in the treatment of esophageal anastomotic leaks suggested a higher success rate for EVT. The ESOLEAK trial is the first study comparing both treatments in a prospective manner. The aim of the trial is to find suitable endpoints for the treatment of anastomotic leaks as well as to enable an adequate sample size calculation and evaluate the feasibility of future interventional trials. Due to the exploratory design of this pilot study, the sample size is too small to answer the question, whether EVT or SEMS implantation represents the superior treatment strategy. Trial registration ClinicalTrials.gov NCT03962244. Registered on May 23, 2019. DRKS-ID DRKS00007941

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