Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system.
BACKGROUND
Endoscopic treatment options for postsurgical intrathoracic leaks include injection of fibrin glue, clip application, and stent placement. Endoscopic vacuum-assisted closure (E-VAC) may be an effective treatment option.


OBJECTIVE
To demonstrate that E-VAC is an effective endoscopic treatment option for closure of major intrathoracic postsurgical leaks.


METHODS
A prospective, single-center study at an academic medical center.


METHODS
Eight consecutive patients with major intrathoracic postsurgical leaks.


METHODS
Endoscopic placement of transnasal draining tubes, armed with a size-adjusted sponge at their distal end, in the necrotic anastomotic cavities, followed by continuous suction. Sponge and drainage were changed twice weekly. Patients were followed-up for 193 +/- 137 days.


METHODS
Successful leak closure.


RESULTS
Successful closure of leaks was achieved in 7 of 8 patients (88%) after a mean of 23 +/- 8 days. A median of 7 endoscopic interventions was necessary. No major treatment-associated short-term or long-term (follow-up, 193 +/- 137 days) complications were noted.


CONCLUSIONS
Small sample size, single-center study, and lack of randomization.


CONCLUSIONS
E-VAC is an effective endoscopic treatment modality for major postsurgical intrathoracic leaks. (This study is registered at Clinicaltrials.gov, identifier NCT00876551.).
Wedemeyer
Jochen
J
Department of Gastroenterology, Medical School of Hannover, Hannover, Germany.
Brangewitz
Mira
M
Kubicka
Stefan
S
Jackobs
Steffan
S
Winkler
Michael
M
Neipp
Michael
M
Klempnauer
Jürgen
J
Manns
Michael P
MP
Schneider
Andrea S
AS
D000046:Academic Medical Centers; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy / Q000379:methods; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013896:Thoracic Diseases / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome