Treatment of Thoracic Esophageal Anastomotic Leaks and Esophageal Perforations with Endoluminal Stents: Efficacy and Current Limitations

Tuebergen, Dirk; Rijcken, Emile; Mennigen, Rudolf; Hopkins, Ann M.; Senninger, N.; Bruewer, Matthias

doi:10.1007/s11605-008-0500-4

Cited by 152 publications

(127 citation statements)

References 43 publications

(67 reference statements)

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“…Hence, several non-surgical options have come insight these years, including endoscopic stenting, vacuum-assisted closure therapy (VACT) and naso-leakage drainage under X-ray fluoroscopy. Whereas, these non-surgical interventions sometimes show certain defects which might lead to a failing management and cause fatal outcomes (9)(10)(11)(12). Therefore, a more effective and less invasive option with quite a safety to heal the leakage and reduce the mortality is urgently needed.…”

Section: Fatal Outcomes Of Ials and Non-surgical Approachesmentioning

confidence: 99%

“…Meanwhile, as for non-surgical options, chest drainage is the most essential method, but usually cannot get sufficient drainage, especially in the mediastinum and top of the chest. Endoscopic interventions such as endoscopic stenting (9,10), endoluminal vacuum therapy (EVT) (11) and endoscopic clamping therapy do show certain effectiveness, but it is also associated with severe complications with a high mortality which could not be ignored. Endoscopic stenting, for example, might cause aortic erosion, immigration of stent and enlargement of leakage (9,10).…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopic interventions such as endoscopic stenting (9,10), endoluminal vacuum therapy (EVT) (11) and endoscopic clamping therapy do show certain effectiveness, but it is also associated with severe complications with a high mortality which could not be ignored. Endoscopic stenting, for example, might cause aortic erosion, immigration of stent and enlargement of leakage (9,10). Moreover, treatment of antibiotics and enteral nutrition are well used today but they are not crucial, and could seldom come into effect alone.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Zhang¹,

Zhang²,

Hu³

et al. 2017

J. Thorac. Dis.

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Background: Intrathoracic anastomotic leakage (IAL) remains a major complication of esophagectomy.Main non-surgical options of management include chest drainage and endoscope interventions. This study is aim to present our experience and assess the efficacy of endoscopic naso-leakage drainage (ENLD) in patients with IAL. Methods: From June 2011 to January 2017, 67 patients who developed IAL after esophagectomy and managed by non-surgical approaches were analyzed retrospectively. IAL was confirmed by clinical presentations combined with the evidence of CT scan, radiography and endoscopy. Thirty-eight patients were treated by conventional chest drainage (CD group) and 29 patients underwent ENLD with or without chest drainage (ENLD group), while other treatments including enteral nutrition and antibiotics had no difference between the two groups. In ENLD group, a 12 Fr naso-leakage tube was placed through the leakage to the bottom of vomica under ultra-slim electronic gastroscope. The naso-leakage tube was then connected to a gastrointestinal decompression device for drainage and was also used for rinse. When the vomica diminished and the drainage was also clean, the naso-leakage tube could be pulled back gradually. Finally, healing of the leakage was confirmed endoscopically. Clinical records of the two groups were analyzed.Results: In ENLD group, naso-leakage tubes were successfully placed under endoscope in all 29 patients without any procedure-related complications. In CD group, the mortality is 7.9% (three patients) and five patients (13.2%) developed to systemic inflammatory response syndrome (SIRS) due to insufficient drainage.While in ENLD group, there was only one patient (3.4%) developed to SIRS and no death was observed, but the difference was not statistically significant. When compared with the CD group, the ENLD group had a shorter healing course (44.2±18.3 vs. 60.5±27.7 days, P=0.008), duration of antibiotics usage (16.4±7.8 vs.11.8±3.8 days, P<0.001) and duration of fever (4.3±2.2 vs. 9.5±8.6 days, P=0.002). Conclusions: To our initial experience, ENLD is an ideal option with safety and efficacy in management of IAL after esophagectomy.

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Section: Fatal Outcomes Of Ials and Non-surgical Approachesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Zhang¹,

Zhang²,

Hu³

et al. 2017

J. Thorac. Dis.

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“…Les endoprothèses couvertes ont également leur place dans les perforations de l'oesophage néoplasique chez les patients inopérables. Elles s'adressent également aux patients présentant une perforation de taille supérieure à 2 cm ou de découverte tardive [24]. La prothèse doit être posée de manière à couvrir 3 à 5 cm en amont et en aval de la perforation.…”

Section: Oesophageunclassified

Traitement endoscopique des perforations iatrogènes

Ghossaini¹,

Lucidarme²,

Bulois³

2013

Hegel

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“…Die Einlage von selbstexpandierenden Stents stellt sicherlich die am weitesten verbreitete Methode zur Behandlung von Anastomosenleckagen dar [13,14,15,16,17,18,19,20,21,22,23]. Es kommen sowohl komplett beschichtete Metallstents (fig.…”

Section: Stentanlageunclassified

Endoskopische Therapie von Nahtinsuffizienzen des Ösophagus

Wedemeyer

2012

Visc Med

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Hintergrund: Nahtinsuffizienzen stellen eine gefürchtete Komplikation nach Operationen an der Speiseröhre dar, die mit hoher Morbidität und Mortalität vergesellschaftet sind. Methoden: Die Einlage komplett beschichteter Stents stellt die am häufigsten eingesetzte Methode zur Behandlung ösophagealer Leckagen dar. Eine neue endoskopische Therapiemodalität besteht mit der endoskopischen Vakuumschwammtherapie. Hierbei macht man sich die positiven Effekte des vakuumassistierten Verschlusses (Vacuum-Assisted Closure, V.A.C.), der eine etablierte Therapiemodalität zur Behandlung ausgedehnter infizierter Hautdefekte darstellt, zunutze. Durch neue Entwicklungen haben auch Clips (insbesondere der «Over-the-Scope-Clip», OTSC) wieder eine Bedeutung beim Verschluss von ösophagealen Nahtinsuffizienzen erhalten. Ergebnisse: Mit diesen endoskopischen Techniken lassen sich Nahtinsuffizienzen des Ösophagus in über 80% der Fälle erfolgreich verschließen. Schlussfolgerung: Endoskopische Techniken stellen eine geeignete Methode zum Verschluss ösophagealer Leckagen dar und konnten daher in den letzten 10 Jahren die chirurgische Revision weitestgehend verdrängen

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Treatment of Thoracic Esophageal Anastomotic Leaks and Esophageal Perforations with Endoluminal Stents: Efficacy and Current Limitations

Abstract: Implantation of self-expanding stents after esophageal resection or perforation is a feasible and safe procedure with an acceptable morbidity even if used as last-choice treatment.

Cited by 152 publications

References 43 publications

Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Traitement endoscopique des perforations iatrogènes

Endoskopische Therapie von Nahtinsuffizienzen des Ösophagus

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