title: Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis.
abstract: OBJECTIVE
  Placement of covered self-expanding metal or plastic stents (SEMS or SEPS) is an established method for managing intrathoracic leaks. Recently, endoscopic vacuum-assisted closure (EVAC) has been described as a new effective treatment option. Our aim was to compare stent placement with EVAC for nonsurgical closure of intrathoracic anastomotic leaks.
  
  
  METHODS
  In a retrospective analysis we were able to identify 39 patients who were treated with SEMS or SEPS and 32 patients who were treated with EVAC for intrathoracic leakage. In addition to successful fistula closure, we analyzed hospital mortality, number of endoscopic interventions, incidence of stenoses, and duration of hospitalization.
  
  
  RESULTS
  In a multivariate analysis, successful wound closure was independently associated with EVAC therapy (hazard ratio 2.997, 95 % confidence interval [95 %CI] 1.568 - 5.729; P = 0.001). The overall closure rate was significantly higher in the EVAC group (84.4 %) compared with the SEMS/SEPS group (53.8 %). No difference was found for hospitalization and hospital mortality. We found significantly more strictures in the stent group (28.2 % vs. 9.4 % with EVAC, P < 0,05).
  
  
  CONCLUSIONS
  EVAC is an effective endoscopic treatment option for intrathoracic leaks and showed higher effectiveness than stent placement in our cohort.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Brangewitz
authors.forename: T
authors.initials: T
authors.lastname: Voigtländer
authors.forename: F A
authors.initials: FA
authors.lastname: Helfritz
authors.forename: T O
authors.initials: TO
authors.lastname: Lankisch
authors.forename: M
authors.initials: M
authors.lastname: Winkler
authors.forename: J
authors.initials: J
authors.lastname: Klempnauer
authors.forename: M P
authors.initials: MP
authors.lastname: Manns
authors.forename: A S
authors.initials: AS
authors.lastname: Schneider
authors.forename: J
authors.initials: J
authors.lastname: Wedemeyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013270:Stomach / Q000601:surgery*; D014945:Wound Healing