Efficacy of Endoscopic Vacuum-Assisted Closure Treatment for Postoperative Anastomotic Leak in Gastric Cancer

Abstract

Background/Aims: Endoscopic vacuum-assisted closure (EVAC) has been attempted as new nonsurgical treatment for anastomotic leakage. We aimed to evaluate the clinical outcomes of EVAC and compare its efficacy with the self-expandable metallic stent (SEMS) for postgastrectomy leakage. Methods: Between January 2007 and February 2018, 39 patients underwent endoscopic treatment for anastomotic leakage after gastric cancer surgery. Of them, 28 patients were treated with SEMS, seven with EVAC after SEMS failure, and four with EVAC. We retrospectively compared the clinical characteristics and therapeutic outcomes between EVAC (n=11) and SEMS (n=28). Results: The median followup duration was 17 months (interquartile range, 9 to 26 months) in both groups. In comparison of clinical characteristics between two groups, only the median size of the leak was larger in the EVAC group than in the SEMS group (2.1 cm vs 1.0 cm; p<0.001). All EVAC cases healed successfully; however, two cases (7.1%) failed to heal in the SEMS group. Anastomotic stricture occurred one case (9.1%) in EVAC and four cases (14.3%) in SEMS within 1 year after endoscopic treatment. The median treatment duration of EVAC was shorter than that of SEMS (15 days vs 36 days; p<0.001). Median weight loss after therapy was similar in both groups (8.0 kg in EVAC vs 9.0 kg in SEMS; p=0.356). Conclusions: EVAC can be effective endoscopic treatment for postgastrectomy anastomotic leakage. Substantial leakage could be an important clinical factor for considering EVAC as a treatment option. Large randomized controlled trials are needed to confirm the efficacy of EVAC.

Treatment of Oesophagojejunostomy Leakage With the Use of Fibrin Glue: Case Report

“…Numerous reports present positive effects of endoscopic therapies, including the implantation of covered stents, use of endoscopic clips, endoscopic negative pressure therapy, and application of tissue glues [5][6][7][8][9][10][11][12][13][14][15][16][17]. Kim et al assessed the effects of endoscopic treatment (the use of clips, glue, or stent implantation) in 33 patients with oesophagojejunostomy leakage.…”

“…Such treatment may be successful even in 73%. The main drawbacks of this treatment include the need to use two or even three stents if the leakage persists, stent migration, and complaints of pain, which are often present for a few days after implantation [ 10 - 11 ].…”

“…In a study comparing treatment with self-expandable stents and EVAC, healing was achieved in all EVAC patients, with 73% healing in the group treated with stents. Moreover, in the EVAC group, larger defects were treated, even such over 3 cm in diameter [ 11 ].…”

“…However, mortality resulting from leakage may reach even 32.5% [4]. With the constant development of minimally invasive and endoscopic techniques, an ever-higher percentage of anastomotic leakages are successfully treated with these methods [5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Endoscopic Vacuum Therapy in Subtotal Esophagogastric Anastomosis Leaks

“…Все это повышает регенераторные способности ткани, способствует повышению метаболической активности, увеличивает приток крови, что стимулирует формирование грануляционной ткани [9]. В связи с этим мы выбрали оптимальный в подобной ситуации метод лечения -эндоскопическую вакуумную терапию [8,[14][15][16][17].…”