Endoscopic Internal Drainage and Low Negative Pressure Endoscopic Vacuum Therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.

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ENDOSCOPIC INTERNAL DRAINAGE VS. LOW NEGATIVE PRESSURE ENDOLUMINAL VACUUM THERAPY FOR LEAKAGES AFTER ONCOLOGIC UPPER GASTROINTESTINAL SURGERY

10.1055/s-0040-1705061 ◽

2020 ◽

Author(s):

CFM Jung ◽

A Müller-Dornieden ◽

R Hallit ◽

M Calmels ◽

U Chaput ◽

...

Keyword(s):

Negative Pressure ◽

Gastrointestinal Surgery ◽

Vacuum Therapy ◽

Internal Drainage ◽

Endoscopic Internal Drainage ◽

Upper Gastrointestinal

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ENDOSCOPIC INTERNAL DRAINAGE (EID) OF SUTURE-LINE DEHISCENCE POST-LAPAROSCOPIC GASTRIC SLEEVE (LGS): SIMPLER THAN ENDOSCOPIC VACUUM THERAPY (EVT) AND MORE EFFECTIVE THAN INTRALUMINAL COVERED SEMS

10.1055/s-0040-1704423 ◽

2020 ◽

Author(s):

JT Tejada ◽

RN Nuñoz ◽

EF Valenzuela ◽

M De Benito Sanz ◽

RSO Hernández ◽

...

Keyword(s):

Suture Line ◽

Vacuum Therapy ◽

Gastric Sleeve ◽

Internal Drainage ◽

Endoscopic Internal Drainage ◽

Endoscopic Vacuum Therapy

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478 Surgical Endoscopic Vacuum Therapy for Defects of the Upper GI Tract

Gastroenterology ◽

10.1016/s0016-5085(15)33782-3 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1110

Author(s):

Florian Kuehn ◽

Florian Janisch ◽

Frank Schwandner ◽

Guido Alsfasser ◽

Leif Schiffmann ◽

...

Keyword(s):

Vacuum Therapy ◽

Gi Tract ◽

Upper Gi ◽

Endoscopic Vacuum Therapy ◽

Upper Gi Tract

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A Complication of an Endoscopic Pigtail Stent Migration into the Cavity during Deployment as a Treatment for Gastric Leak

Case Reports in Surgery ◽

10.1155/2019/6974527 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Abrar A. AlAtwan ◽

Ali AlJewaied ◽

Talal AlKhadher ◽

Mohannad AlHaddad ◽

Iqbal Siddique

Keyword(s):

Sleeve Gastrectomy ◽

Hospital Stay ◽

Gastrointestinal Surgery ◽

Stent Migration ◽

Gastric Leak ◽

Internal Drainage ◽

Endoscopic Internal Drainage ◽

Gastric Leakage ◽

Pigtail Stent

Gastric leak following gastrointestinal surgery is the most dreadful complication, which implies long hospital stay, morbidities, and not irrelevant mortalities. There is no standard recommendation for treating postlaparoscopic sleeve gastrectomy leak, which makes its management challenging. Endoscopic internal drainage by double-pigtail drains currently became the recommended approach. Complications to this approach include bleeding, ulceration at the tip of the double-pigtail stent, and uncommon migration. Here, we report our experience with drain displacement into the cavity while deployment in a patient who experienced gastric leakage after undergoing sleeve gastrectomy.

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VACStent: a new option for endoscopic vacuum therapy in patients with esophageal anastomotic leaks after upper gastrointestinal surgery

Endoscopy ◽

10.1055/a-1047-0244 ◽

2019 ◽

Vol 52 (05) ◽

pp. E166-E167 ◽

Cited By ~ 2

Author(s):

Seung-Hun Chon ◽

Isabel Bartella ◽

Martin Bürger ◽

Isabel Rieck ◽

Tobias Goeser ◽

...

Keyword(s):

Gastrointestinal Surgery ◽

Vacuum Therapy ◽

Anastomotic Leaks ◽

Endoscopic Vacuum Therapy ◽

Upper Gastrointestinal

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Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis

Endoscopy ◽

10.1055/a-1149-1741 ◽

2020 ◽

Vol 52 (08) ◽

pp. 632-642 ◽

Cited By ~ 5

Author(s):

Pasquale Scognamiglio ◽

Matthias Reeh ◽

Karl Karstens ◽

Eugen Bellon ◽

Marcus Kantowski ◽

...

Keyword(s):

Systematic Review ◽

Anastomotic Leakage ◽

Meta Analysis ◽

Treatment Success ◽

Esophageal Surgery ◽

Metal Stents ◽

Vacuum Therapy ◽

Duration Of Treatment ◽

Median Difference ◽

Endoscopic Vacuum Therapy

Abstract Background Esophageal anastomotic leakage still represents a challenging complication after esophageal surgery. Endoscopically placed self-expandable metal stents (SEMS) are the treatment of choice, but since the introduction of endoscopic vacuum therapy (EVT) for esophageal leakage 10 years ago, increasing evidence has demonstrated that EVT might be a superior alternative. Therefore, we performed a systematic review and meta-analysis to compare the effectiveness and related morbidity of SEMS and EVT in the treatment of esophageal leak. Methods We systematically searched for studies comparing SEMS and EVT to treat anastomotic leakage after esophageal surgery. Predefined end points including outcome, treatment success, endoscopy, treatment duration, hospitalization time, morbidity, and mortality were assessed and included in the meta-analysis. Results Five retrospective studies including 274 patients matched the inclusion criteria. Compared with stenting, EVT was significantly associated with a higher rate of leak closure (odds ratio [OR] 3.14, 95 % confidence interval [CI] 1.23 to 7.98), more endoscopic device changes (pooled median difference of 3.09; 95 %CI 1.54 to 4.64]), a shorter duration of treatment (pooled median difference –11.90 days; 95 %CI –18.59 to –5.21 days), and a lower mortality rate (OR 0.39, 95 %CI 0.18 to 0.83). There were no significant differences in short-term and major complications. Conclusions Owing to the retrospective quality of the studies with potential biases, the results of the meta-analysis must be interpreted with caution. However, the analysis indicates the potential benefit of EVT, which should be further investigated with standardized and prospectively collected data.

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