Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae

Siddiqi, Shirin; Schraufnagel, Dean P.; Siddiqui, Hafiz Umair; Javorski, Michael J.; Mace, Adam G.; Elnaggar, Abdulrhman S.; Elgharably, Haytham; Vargo, Patrick R.; Steffen, Robert; Hasan, Sibah; Raja, Siva

doi:10.1080/17434440.2019.1582329

Cited by 15 publications

(9 citation statements)

References 129 publications

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“…EAL can affect the operative efficacy of esophageal cancer, prolong hospital stays and increase postoperative mortality (2,(5)(6)(7)(8)(9)(10)(11). EAL can even impair patient quality of life, long-term survival of esophageal cancer and subsequent treatment of esophageal masses using strategies such as adjuvant chemoradiotherapy (2,6,8,10,25). Finally, because EAL potentially causes subsequent critical postoperative complications, such as intrathoracic abscess, tracheoesophageal fistula and hemorrhage, both predicting and FIGURE 4 | Overall healing of patients with EAL based on landmark analysis and corresponding hazard ratios.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment strategies included a 'wait and see' strategy (endoscopic diagnostic group), administration of tissue sealant, the use of an endoscopic clip or the application of combined therapy (endoscopic intervention group). Endoscopic treatment was systematically performed until an effective outcome was achieved or the patient died (6).…”

Section: Endoscopic Interventionmentioning

confidence: 99%

“…Once esophageal cancer is confirmed, radical resection is typically recommended, as it is of the most effective therapeutic approaches for select patients. Despite the considerable improvement in surgical conditions and skills, however, esophagectomies are still associated with various complications, of which anastomotic leakage is a disastrous postoperative complication that seriously affects patient quality of life due to both its high incidence (5-40%) and associated mortality (2-60%) (2)(3)(4)(5)(6)(7)(8)(9). As a consequence, improvements in leak management are of vital necessity to reduce overall mortality.…”

Section: Introductionmentioning

confidence: 99%

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An Approach to Accelerate Healing and Shorten the Hospital Stay of Patients With Anastomotic Leakage After Esophagectomy: An Explorative Study of Systematic Endoscopic Intervention

Zhong

Tan

et al. 2021

Front. Oncol.

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ObjectiveTo explore the comprehensive role of systemic endoscopic intervention in healing esophageal anastomotic leak.MethodsIn total, 3919 consecutive patients with esophageal cancer who underwent esophagectomy and immediate esophageal reconstruction were screened. In total, 203 patients (5.10%) diagnosed with anastomotic leakage were included. The participants were divided into three groups according to differences in diagnosis and treatment procedures. Ninety-four patients received conventional management, 87 patients received endoscopic diagnosis only, and the remaining 22 patients received systematic endoscopic intervention. The primary endpoint was overall healing of the leak after oncologic esophageal surgery. The secondary endpoints were the time from surgery to recovery and the occurrence of adverse events.Results173 (85.2%; 95% CI, 80.3-90.1%) of the 203 patients were successfully healed, with a mean healing time of 66.04 ± 3.59 days (median: 51 days; range: 13-368 days), and the overall healing rates differed significantly among the three groups according to the stratified log-rank test (P<0.001). The median healing time of leakage was 37 days (95% CI: 33.32-40.68 days) in the endoscopic intervention group, 51 days (95% CI: 44.86-57.14 days) in the endoscopic diagnostic group, and 67 days (95% CI: 56.27-77.73 days) in the conventional group. The overall survival rate was 78.7% (95% CI: 70.3 to 87.2%) in the conventional management group, 89.7% (95% CI: 83.1 to 96.2%) in the endoscopic diagnostic group and 95.5% (95% CI: 86.0 to 100%) in the systematic endoscopic intervention group. Landmark analysis indicated that the speed of wound healing in the endoscopic intervention group was 2-4 times faster at any period than that in the conservative group. There were 20 (21.28%) deaths among the 94 patients in the conventional group, 9 (10.34%) deaths among the 87 patients in the endoscopic diagnostic group and 1 (4.55%) death among the 22 patients in the endoscopic intervention group; this difference was statistically significant (Fisher exact test, P < 0.05).ConclusionTailored endoscopic treatment for postoperative esophageal anastomotic leakage based on endoscopic diagnosis is feasible and effective. Systematic endoscopic intervention shortened the treatment period and reduced mortality and should therefore be considered in the management of this disease.

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Section: Discussionmentioning

confidence: 99%

Section: Endoscopic Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An Approach to Accelerate Healing and Shorten the Hospital Stay of Patients With Anastomotic Leakage After Esophagectomy: An Explorative Study of Systematic Endoscopic Intervention

Zhong

Tan

et al. 2021

Front. Oncol.

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“…Recently, the use of vacuum assisted dressings (endo sponge) placement has also been proposed to control extra-luminal sepsis and promoted wound healing, however has the associated complication of bleeding up to 10% of the time. This vacuum system is replaced endoscopically every 48–72 hours until the defect is closed ( 43 ).…”

Section: Thoracic Esophageal Trauma Treatmentmentioning

confidence: 99%

Non-iatrogenic esophageal trauma: a narrative review

Schraufnagel¹,

Mubashir²,

Raymond³

2022

Mediastinum

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Background and Objective Non-iatrogenic esophageal trauma is a rare entity that has a high morbidity and mortality. The diagnosis can often be quite challenging, however is critical to perform in a timely manner. The workup and management of non-iatrogenic trauma continues to evolve, with new innovative approaches available for both diagnosis and treatment. The aim of this narrative review is to comprehensively describe the incidence, presentation, workup, treatment approaches and outcomes of non-iatrogenic esophageal trauma. Methods A thorough literature review was performed using full length articles available in English via PubMed between January 1, 1960 to September 30, 2021, focusing on the epidemiology, workup and treatment of non-iatrogenic esophageal trauma, including current surgical techniques. Key Content and Findings Injuries to the cervical esophagus are more common than injuries to the thoracic esophagus, occurring more in young males, with significant racial disparity. Penetrating trauma via gunshot wounds are the most common forms of injury, followed by stab wounds and blunt trauma. Workup is multimodal and involves a combination of plain radiographs, computed tomography (CT) scans, endoscopy and fluoroscopy depending of the stability of the patient and associated injuries. Conclusions Workup and management of non-iatrogenic esophageal trauma depends on the location and extent of esophageal injury, and can include observation, debridement and drainage, esophageal diversion, endoscopic approaches or esophagectomy, with indications, techniques and outcomes described in further detail in this review.

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“… 3 , 4 , 5 In hemodynamically unstable patients or patients with extreme esophageal destruction, this type of injury may warrant a damage-control operation with esophageal diversion. 1 , 6 Over the past decade, as technology and techniques have advanced, our ability to manage these injuries in a less-invasive manner has become more prevalent. 7 , 8 , 9 Techniques in flexible endoscopy, advanced fluoroscopy, and esophageal stenting and clipping have introduced new methods for minimally invasive management of these complex injuries.…”

mentioning

confidence: 99%

Transluminal minimally invasive management of esophageal gunshot wound: The Houdini and friends

et al. 2022

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Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae

Cited by 15 publications

References 129 publications

An Approach to Accelerate Healing and Shorten the Hospital Stay of Patients With Anastomotic Leakage After Esophagectomy: An Explorative Study of Systematic Endoscopic Intervention

An Approach to Accelerate Healing and Shorten the Hospital Stay of Patients With Anastomotic Leakage After Esophagectomy: An Explorative Study of Systematic Endoscopic Intervention

Non-iatrogenic esophageal trauma: a narrative review

Transluminal minimally invasive management of esophageal gunshot wound: The Houdini and friends

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