title: Digital subtraction angiography-guided esophagography, intraluminal drainage, and endoscopic clipping-complex managements for intrathoracic esophagogastric anastomotic leak.
abstract: Intrathoracic esophagogastric anastomotic leak is a critical complication after esophagectomy. Recently, novel complex diagnostic and therapeutic managements for intrathoracic esophagogastric anastomotic leak have been performed at our institution.
  
  
  
  Sixty-seven consecutive patients with intrathoracic esophagogastric anastomotic leak after esophagectomy from January 2009 to May 2015 at our institution were reviewed. Thirty-nine patients received conventional managements (conventional group), in which they were diagnosed via contrast swallow when there was a suspicion of anastomotic leak and were subsequently treated with a metallic stent. Twenty-eight patients received complex managements (complex group), in which they were diagnosed using digital subtraction angiography, an intraluminal drainage tube was placed, and clips were subsequently performed under an endoscope. The outcomes of the two groups were retrospectively analyzed.
  
  
  
  There were no significant differences (P > 0.05) between the two groups in the preoperative general clinical data, whereas the postoperative data exhibited some differences. Compared with the conventional group, the confirmation time and recovery time are significantly decreased in the complex group (P < 0.01 and P < 0.01, respectively), and the incidence of severe complications is also lower (P < 0.01); however, there were no significant differences in the mortality rate between the two groups (P > 0.05).
  
  
  
  Complex managements may represent a useful therapeutic option for postoperative esophagogastric anastomotic leak.
authors.affiliation: The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.affiliation: The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
authors.forename: Shaomu
authors.initials: S
authors.lastname: Chen
authors.affiliation: The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Bian
authors.affiliation: The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
authors.forename: Hongya
authors.initials: H
authors.lastname: Xie
authors.affiliation: The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Ma
authors.affiliation: The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China. Electronic address: 976472757@qq.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Ni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000628:therapy*; D015901:Angiography, Digital Subtraction; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D016629:Esophagectomy; D004945:Esophagoscopy / Q000295:instrumentation / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
keywords: Anastomotic leak; Clip; Endoscope; Esophageal carcinoma; Esophagectomy; Stent