Abstract
Esophagogastric anastomotic leaks occur not infrequently and carry the potential for significant morbidity and mortality. The risk to patients can be mitigated by prompt recognition and appropriate treatment of the anastomotic complication. As with any deep space infection, the overarching principles of management include resuscitation, antibiosis, drainage of the space, and control of ongoing soilage. With advancements in endoscopic technique and equipment, conduit-preserving treatment of anastomotic leaks have been developed. In appropriately selected patients, endoscopic dilation, endoscopic stent placement, endoluminal vacuum therapy, endoscopic clipping, endoscopic suturing, or a combination of these techniques have been used to successfully manage anastomotic leaks. When endoscopic management is successful, the esophagogastric anastomosis is left in situ without need for resection and diversion. Regardless of the endoscopic technique utilized, the presence of anastomotic leak alone portends an increased risk of anastomotic stricture. The treatment of anastomotic leaks should be individualized and more invasive techniques may be required in unstable patients or with failure of less invasive options.
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Bibliography
Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256(1):95–103.
Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246(3):363–72.
Linden PA, Towe CW, Watson TJ, Low DE, Cassivi SD, Grau-Sepulveda M, et al. Mortality after esophagectomy: analysis of individual complications and their association with mortality. J Gastrointest Surg. 2020;24(9):1948–54.
Moon SW, Kim JJ, Cho DG, Park JK. Early detection of complications: anastomotic leakage. J Thorac Dis. 2019;11(Suppl 5):S805–11.
Fabbi M, Hagens ERC, van Berge Henegouwen MI, Gisbertz SS. Anastomotic leakage after esophagectomy for esophageal cancer: definitions, diagnostics, and treatment. Dis Esophagus. 2020;34(1):doaa039.
Schuchert MJ, Abbas G, Nason KS, Pennathur A, Awais O, Santana M, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery. 2010;148(4):831–8.
Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D’Journo XB, et al. International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG). Ann Surg. 2015;262(2):286–94.
Orringer MB, Lemmer JH. Early dilation in the treatment of esophageal disruption. Ann Thorac Surg. 1986;42(5):536–9.
Dasari BVM, Neely D, Kennedy A, Spence G, Rice P, Mackle E, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014;259(5):852–60.
Ong GKB, Freeman RK. Endoscopic management of esophageal leaks. J Thorac Dis. 2017;9(Suppl 2):S135–45.
Nguyen NT, Rudersdorf PD, Smith BR, Reavis K, Nguyen X-MT, Stamos MJ. Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting. J Gastrointest Surg. 2011;15(11):1952–60.
D’Cunha J, Rueth NM, Groth SS, Maddaus MA, Andrade RS. Esophageal stents for anastomotic leaks and perforations. J Thorac Cardiovasc Surg. 2011;142(1):39–46.e1.
Kamarajah SK, Bundred J, Spence G, Kennedy A, Dasari BVM, Griffiths EA. Critical appraisal of the impact of oesophageal stents in the management of oesophageal anastomotic leaks and benign oesophageal perforations: an updated systematic review. World J Surg. 2020;44(4):1173–89.
Virgilio E, Ceci D, Cavallini M. Surgical endoscopic vacuum-assisted closure therapy (EVAC) in treating anastomotic leakages after major resective surgery of esophageal and gastric cancer. Anticancer Res. 2018;38(10):5581–7.
Bludau M, Fuchs HF, Herbold T, Maus MKH, Alakus H, Popp F, et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc. 2018;32(4):1906–14.
Gubler C, Vetter D, Schmidt HM, Müller PC, Morell B, Raptis D, et al. Preemptive endoluminal vacuum therapy to reduce anastomotic leakage after esophagectomy: a game-changing approach? Dis Esophagus. 2019;32(7):doy126.
Watkins JR, Farivar AS. Endoluminal therapies for esophageal perforations and leaks. Thorac Surg Clin. 2018;28(4):541–54.
Kobara H, Mori H, Nishiyama N, Fujihara S, Okano K, Suzuki Y, et al. Over-the-scope clip system: a review of 1517 cases over 9 years. J Gastroenterol Hepatol. 2019;34(1):22–30.
Gaur P, Lyons C, Malik TM, Kim MP, Blackmon SH. Endoluminal suturing of an anastomotic leak. Ann Thorac Surg. 2015;99(4):1430–2.
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The authors acknowledge Mrs. Kathy Lovas for her expert editorial assistance.
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Dr. Sarkaria has received compensation for education, speaking, and/or consulting from Intuitive Surgical, Auris Medical, AMSI, and Cambridge Medical Robotics.
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Ackerman, J.M., Levy, R.M., Sarkaria, I.S. (2023). Endoscopic Management of Anastomotic Leaks. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_25
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