title: Comparison of Endoscopic Vacuum Therapy Versus Stent for Anastomotic Leak After Esophagectomy.
abstract: BACKGROUND
  Endoscopic vacuum therapy is a novel option for the management of esophageal leaks. This study compares endoscopic vacuum therapy versus placement of covered stents for anastomotic leaks after esophagectomy.
  
  
  METHODS
  N = 45 consecutive patients with anastomotic leaks following esophagectomy (including patients referred to our center from other hospitals for complication management) were managed by endoscopic therapy at our institution from January 2009 to February 2015. Outcomes of stent and endoscopic vacuum therapy were analyzed retrospectively.
  
  
  RESULTS
  Thirty patients received endoscopic stent placement and 15 endoscopic vacuum therapy. In the stent group, seven patients were switched to endoscopic vacuum and four to surgery. Classified by type of initial endoscopic therapy, the success rate (anastomotic healing, patient recovered) was higher for endoscopic vacuum therapy (endoscopic vacuum 93.3%, stent 63.3 %; p = 0.038). Classified by final endoscopic therapy (after switches in therapy), success rates were 86.4 and 60.9% (p = 0.091), respectively. There was no difference observed in mortality, duration of therapy, and length of hospital stay between the study groups.
  
  
  CONCLUSIONS
  Endoscopic vacuum therapy might be more effective than endoscopic stent placement in the management of esophageal anastomotic leaks.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Geb. W1, D-48149, Muenster, Germany, rudolf.mennigen@ukmuenster.de.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mennigen
authors.forename: Carolin
authors.initials: C
authors.lastname: Harting
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lindner
authors.forename: Thorsten
authors.initials: T
authors.lastname: Vowinkel
authors.forename: Emile
authors.initials: E
authors.lastname: Rijcken
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Mike G
authors.initials: MG
authors.lastname: Laukoetter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014618:Vacuum