Endoscopic vacuum therapy for intrathoracic anastomotic insufficiencies following oncological resections

Wichmann, Dörte; Schempf, Ulrike; Mothes, Benedikt; Stüker, D; Königsrainer, Alfred; Schweizer, Ulrich; Werner, Christoph R.

doi:10.21037/aoe.2019.08.03

Cited by 4 publications

(9 citation statements)

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“…The reported success rates of EVT for anastomotic leakages are high (66-100%) (12,13,36,39,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Accordingly, adverse event rates are low (0-14.8%) (12,39,47,51,52). These data are consistent with the results of our current study, which indicates a success rate of 89.1% and an overall procedure-related adverse event rate of only 5.4%.…”

Section: Discussionsupporting

confidence: 91%

“…These considered small patient cohorts with only 1-39 patients (12,39,47). The reported success rates of EVT for anastomotic leakages are high (66-100%) (12,13,36,39,(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Accordingly, adverse event rates are low (0-14.8%) (12,39,47,51,52).…”

Section: Discussionmentioning

confidence: 99%

“…Different case reports or case series show favorable results to EVT in terms of sealing rates. Reported treatment success ranges from 66.7-100% (38,39). However, evidence on EVT application in the upper GI tract is still rare and mostly based on small retrospective study cohorts with heterogeneous esophageal defects of different etiologies, e.g.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

Zhang

Liesenfeld

Klotz

et al. 2020

Preprint

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BackgroundAnastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening adverse events. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection. MethodsFrom 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. ResultsFifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n=49) by EVT only. The EVT-associated adverse event rate was 5.4% (n=3): bleeding occurred in one patient, while minor sedation-related adverse events 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. ConclusionsEVT 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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

Zhang

Liesenfeld

Klotz

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Different case reports or case series show favorable results to EVT in terms of sealing rates. Reported treatment success ranges from 66.7 to 100% [38,39]. However, evidence on EVT application in the upper GI tract is still rare and mostly based on small retrospective study cohorts with heterogeneous esophageal defects of different etiologies, e.g.…”

Section: Introductionmentioning

confidence: 99%

“…However, evidence on EVT application in the upper GI tract is still rare and mostly based on small retrospective study cohorts with heterogeneous esophageal defects of different etiologies, e.g. benign perforations and postoperative anastomotic leakages [12,24,25,39].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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).

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Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature

Kamaleddine¹,

Popova²,

Alwali³

et al. 2023

Visc Med

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An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.

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Endoscopic vacuum therapy for intrathoracic anastomotic insufficiencies following oncological resections

Cited by 4 publications

References 0 publications

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

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

Endoscopic Vacuum Therapy for Treating an Esophago-Pulmonary Fistula after Esophagectomy: A Case Report and Review of the Literature

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