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Self-Expanding Metal Stents Versus Endoscopic Vacuum Therapy in Anastomotic Leak Treatment After Oncologic Gastroesophageal Surgery

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Anastomotic leak after gastroesophageal surgery is a life-threatening complication. Self-expanding metal stent (SEMS) implantation or endoscopic vacuum therapy (EVT) have been established as alternatives to reoperation. This study compares the outcome of both interventions for anastomotic leak clinical management.

Methods

In this retrospective study, we identified all patients who received SEMS or EVT for anastomotic leaks after oncological gastroesophageal surgery between January 2007 and December 2016. Only patients with type II leaks according to the Esophagectomy Complications Consensus Group were included. Sealing rates, intervention-related complications, demographic characteristics, clinical history, leak characteristics, therapy duration, and in-hospital mortality were analyzed.

Results

One hundred eleven patients who received SEMS (n = 76) or EVT (n = 35) were identified and categorized by primary and final treatment. The overall closure rate in the final treatment analysis was 85.7% for EVT and 72.4% for SEMS (p = 0.152). ICU stay ranged from 0 to 60 days (median 6 days) for EVT and from 0 to 295 days (median 9 days) for SEMS (p = 0.704). EVT patients were hospitalized for 19–119 days (median 39 days) and SEMS patients for 13–296 days (median 37 days; p = 0.812). Demographic factors, comorbidities, and surgical parameters did not correlate with treatment or treatment success.

Conclusions

SEMS and EVT show comparable results for anastomotic leak management after oncologic gastroesophageal surgery. No superior outcome could be found for either one of the two treatments options.

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Abbreviations

H.S.:

Hartmut Schäfer

T.H.:

Till Herbold

S.C.:

Seung-Hun Chon

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Acknowledgments

We would like to thank all the nurses in our surgical endoscopy department for their expert technical assistance. We thank Lisa-Maria Teubler for proofreading. We thank Dr. Thomas Dratsch for the statistical consultation. We thank Hartmut Schäfer for his technical expertise and his guidance as interventional endoscopist.

Author information

Author notes

  1. Felix Berlth and Marc Bludau contributed equally to this work.

Authors and Affiliations

  1. Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Felix Berlth, Marc Bludau, Patrick Sven Plum, Hakan Alakus, Robert Kleinert, Christiane Josephine Bruns & Seung-Hun Chon

  2. Department of General, Visceral and Transplantation Surgery, RWTH Aachen, Aachen, Germany

    Till Herbold

  3. Institute of Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany

    Hildegard Christ

  4. Center for Esophageal and Gastric Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany

    Arnulf Heinrich Hölscher

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  1. Felix Berlth
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Contributions

Felix Berlth:

• Conception and design

• Acquisition of data

• Analysis of data

• Interpretation of data

• Drafting the work

• Final approval of the manuscript

Marc Bludau:

• Conception and design

• Acquisition of data

• Analysis of data

• Interpretation of data

• Revising the work

• Final approval of the manuscript

Patrick Sven Plum:

• Acquisition of data

• Interpretation of data

• Revising the work

• Final approval of the manuscript

Till Herbold:

• Acquisition of data

• Interpretation of data

• Revising the work

• Final approval of the manuscript

Hildegard Christ:

• Analysis of data

• Interpretation of data

• Revising the work

• Final approval of the manuscript

Hakan Alakus:

• Interpretation of data

• Revising the work

• Final approval of the manuscript

Robert Kleinert:

• Acquisition of data

• Revising the work

• Final approval of the manuscript

Christiane Josephine Bruns:

• Design

• Revising the work

• Final approval of the manuscript

Arnulf Heinrich Hölscher:

• Design

• Revising the work

• Final approval of the manuscript

Seung-Hun Chon:

• Conception and design

• Acquisition of data

• Analysis of data

• Interpretation of data

• Drafting the work

• Final approval of the manuscript

Corresponding author

Correspondence to Seung-Hun Chon.

Additional information

DDW 2018 SSAT PLENARY PRESENTATION, Washington D.C

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Berlth, F., Bludau, M., Plum, P.S. et al. Self-Expanding Metal Stents Versus Endoscopic Vacuum Therapy in Anastomotic Leak Treatment After Oncologic Gastroesophageal Surgery. J Gastrointest Surg 23, 67–75 (2019). https://doi.org/10.1007/s11605-018-4000-x

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  • DOI: https://doi.org/10.1007/s11605-018-4000-x

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