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. 2022 Mar 31;20(1):104.
doi: 10.1186/s12957-022-02551-z.

Anastomotic leakage following resection of the esophagus-introduction of an endoscopic grading system

Jeannine Bachmann  1 , Marcus Feith  2 , Christoph Schlag  3 , Mohamed Abdelhafez  3 , Marc E Martignoni  2 , Helmut Friess  2
Affiliations

Anastomotic leakage following resection of the esophagus-introduction of an endoscopic grading system

Jeannine Bachmann et al. World J Surg Oncol. .

Abstract

Background: Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage.

Methods: Patients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. Endoscopy In this retrospective analysis, the focus is to describe different patterns of leakage of the anastomosis.

Results: We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With the increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of the development of a fistula to the tracheobronchial system increased with higher grades of leakage.

Conclusions: Exact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with a special focus on prospective analysis.

Keywords: Anastomotic leakage; Endoluminal vacuum therapy; Endoscopic grading system.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Endoscopic views with regard to leakage grading. a Anastomosis on day 6 after the operation. b Leakage grade 1a: dehiscence of the anastomosis less than a quarter of the circumference without a cavity. c Leakage grade 1b: rosy tubular stomach, dehiscence of the anastomosis less than a quarter of the circumference, with a cavity. d Leakage grade 2: rosy tubular stomach, dehiscence of the anastomosis more than a quarter of the circumference, with a cavity. e Leakage grade 3: the necrotic mucosal layer of the tubular stomach. f Leakage grade 4: the necrotic wall of the tubular stomach
Fig. 2
Fig. 2
Algorithm: detection of leakage severity and recommended treatment
See this image and copyright information in PMC

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