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. 2021 Feb 16;21(1):72.
doi: 10.1186/s12876-021-01651-6.

Feasibility, effectiveness, and safety of endoscopic vacuum therapy for intrathoracic anastomotic leakage following transthoracic esophageal resection

Chengcheng Christine Zhang  1 , Lukas Liesenfeld  2 , Rosa Klotz  2 , Ronald Koschny  3 , Christian Rupp  3 , Thomas Schmidt  2 , Markus K Diener  2 , Beat P Müller-Stich  2 , Thilo Hackert  2 , Peter Sauer  3 , Markus W Büchler  2 , Anja Schaible  2
Affiliations

Feasibility, effectiveness, and safety of endoscopic vacuum therapy for intrathoracic anastomotic leakage following transthoracic esophageal resection

Chengcheng Christine Zhang et al. BMC Gastroenterol. .

Abstract

Background: Anastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening complications. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This retrospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection.

Methods: From March 2014 to September 2019 259 consecutive patients underwent elective transthoracic esophageal resection. 72 patients (27.8%) suffered from AL. The overall collective in-hospital mortality rate was 3.9% (n = 10). Data from those who underwent treatment with EVT were included.

Results: Fifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n = 49) by EVT only. The EVT-associated complication rate was 5.4% (n = 3): bleeding occurred in one patient, while minor sedation-related complications were observed in two patients. The median number of EVT procedures per patient was 3. The procedures were performed at intervals of 3-5 days, with a 14-day median duration of therapy. The mortality rate of patients with AL was 7.2% (n = 4). Despite successfully terminated EVT, three patients died because of multiple organ failure, acute respiratory distress syndrome, and urosepsis (5.4%). One patient (1.8%) died during EVT due to cardiac arrest.

Conclusions: EVT is a safe and effective approach for intrathoracic anastomotic leakages following abdomino-thoracic esophageal resections. It offers a high leakage-closure rate and the potential to lower leakage-related mortalities.

Trial registration: This trial was registered and approved by the Institutional Ethics Committee of the University of Heidelberg on 16.04.2014 (Registration Number: S-635/2013).

Keywords: Anastomotic leakage; Endoscopic vacuum therapy; Endoscopy; Negative-pressure therapy; Postoperative complications.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Anastomotic leakage and treatment by endoscopic vacuum therapy (EVT). a Anastomotic leakage before treatment. b Closure of the defect and recovery of the mucosal surface after EVT
Fig. 2
Fig. 2
Study flow chart. Different treatment strategies of patients with anastomotic leakage during the study period. EVT: endoscopic vacuum therapy, SEMS: self-expanding metal stent
Fig. 3
Fig. 3
Inflammatory markers during EVT. a CRP levels before the beginning of EVT decrease significantly compared to CRP levels one day after the termination of EVT. b White blood cell count (WBC) before EVT shows a significant reduction compared to values obtained one day after the termination of EVT. Pre-EVT: values before EVT. Post-EVT: values one day after termination of EVT. *** indicates a p value ≤ 0.001
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