Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks.
BACKGROUND
Management of intrathoracic anastomotic leaks remains an interdisciplinary challenge. Established treatment options include percutaneous drainage, endoscopic closure, or even surgical revision. All these procedures are associated with high morbidity and mortality rates.


OBJECTIVE
We report a new, effective endoscopic treatment option for intrathoracic esophageal anastomotic leaks by using an endoscopic vacuum-assisted closure system.


METHODS
Two patients with intrathoracic anastomotic leaks after esophagectomy and gastrectomy were included.


METHODS
Surgical reinterventions failed to seal the leaks in 1 patient, whereas in the other patient the anastomotic leakage persisted after endoscopic placement of 2 covered self-expanding metal stents. We endoscopically placed transnasal draining tubes that were armed with a size-adjusted sponge at their distal tip in the necrotic anastomotic cavities. Continuous suction was applied. Sponge and drain were changed twice a week.


RESULTS
No complications were noted during the course of treatment. After a median of 15 days, closure of the wound cavities was achieved in all cases. A median of 5 endoscopic interventions was necessary. Both patients returned gradually to a solid diet without recurrence of the leaks.


CONCLUSIONS
Endoscopic vacuum-assisted closure might be an effective alternative in the treatment of upper intestinal anastomotic leaks.
Wedemeyer
Jochen
J
Department of Gastroenterology, Hepatology, and Endocrinology, Medical School of Hannover, Hannover, Germany.
Schneider
Andrea
A
Manns
Michael P
MP
Jackobs
Steffan
S
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D020878:Device Removal / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004943:Esophagogastric Junction; D004947:Esophagus / Q000601:surgery*; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D014618:Vacuum