[Endoscopic treatment of mediastinal anastomotic leaks].
BACKGROUND
Surgery, as well as conservative treatment, in patients with clinically apparent intrathoracic anastomotic leaks are often associated with poor results and carry a high morbidity and mortality. This report describes our results with the endoscopic treatment of intrathoracic anastomotic leakages.


METHODS
27 consecutive patients presenting with clinically apparent intrathoracic anastomotic leak, caused by resection of an epiphrenic diverticulum (n=1), esophagectomy for esophageal cancer (n=19), limited resection for carcinoma of the gastroesophageal junction (n=1) or gastrectomy for gastric cancer (n=6) were endoscopically treated. The extent of the dehiscences ranged from about 10-70%. After endoscopic lavage and debridement of the leakage (mean duration: 16,8 days) the leaks were closed with fibrin clue (n=9) or endoclips (n=2) in cases of smaller leaks or by stent placement (n=11), stent placement after unsuccessful fibrin clue injections (n=3) or stent placement and endoclipping (n=1) in patients with a large leakage. Simultaneously the periesophageal mediastinum was drained by chest drains.


RESULTS
25 of 27 patients were successfully treated endoscopically. Under endoscopic treatment one patient died due to septic multiorgan failure. Another patient developed a refractory, persistent leak. Procedure related complications (stent migration, anastomotic stenosis) were obtained in 6 patients.


CONCLUSIONS
An endoscopic approach is successful and safe to treat symptomatic intrathoracic anastomotic leaks smaller than 70% of the circumference. An endoscopic lavage and debridement of the leak, prior to leak closure, seems to be helpful to reduce mediastinal and pleural inflammation. In patients with smaller leaks (<30%) fibrin clue injections and endoclipping is recommended. Patients with a dehiscence from 30-70% of the circumference profit from stent placement.
Schubert
D
D
Klinik für Allgemein-Viszeral-und Gefässchirurgie, Otto von Guericke-Universität Magdeburg. schubertdr@hotmail.com
Pross
M
M
Nestler
G
G
Ptok
H
H
Scheidbach
H
H
Fahlke
J
J
Lippert
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003646:Debridement; D004936:Diverticulum, Esophageal / Q000601:surgery; D004724:Endoscopy; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D015718:Fibrin Tissue Adhesive; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D015607:Stents; D013274:Stomach Neoplasms / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000601:surgery; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive