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Endoscopic vacuum therapy for post-esophagectomy anastomotic dehiscence as rescue treatment: a single center case series

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Abstract

Background

Endoscopic vacuum therapy (EVT) represents an effective endoscopic technique for the treatment of post-esophagectomy leaks and can be used after failure of primary treatment. We aimed to investigate endoscopic data and success rate of EVT for post-esophagectomy anastomotic leaks, after failed redo surgery or previous endoscopic treatment.

Methods

We retrospectively recruited 12 patients from January 2018 to October 2020. Success was defined as dehiscence closure at radiological and/or endoscopic evaluation. Ethical Committee of our institution approved the study.

Results

Twelve patients (66.7% male, mean age 65.08 ± 16.7 years) affected by esophago-gastric (n = 10) or esophago-jejunal (n = 2) anastomosis dehiscences after oncologic surgery were treated with EVT, after failure of previous redo-surgical (n = 3, 25%) or endoscopic management (n = 9, 75%). Technical success rate was 100% (60/60 procedures) and dehiscence closure was achieved in three quarters of patients (9/12, 75%). Regarding complications, one case of sponge dislocation (1/60 = 1.7%) and another case of delayed stricture after post-EVT stent placement (1/60 = 1.7%) were recorded, during a mean follow up of 182.3 days.

Conclusions

EVT is a promising option in the treatment of the most complicated anastomotic dehiscences. Its use could be also considered after failure of previous endoscopic or surgical management.

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Acknowledgements

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Authors and Affiliations

  1. Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy

    Francesco Vito Mandarino, Alberto Barchi, Lorella Fanti, Ferdinando D’Amico, Francesco Azzolini, Dario Esposito, Paolo Biamonte, Gaetano Lauri & Silvio Danese

  2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Ferdinando D’Amico

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  1. Francesco Vito Mandarino
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  2. Alberto Barchi
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  4. Ferdinando D’Amico
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  5. Francesco Azzolini
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  6. Dario Esposito
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Contributions

FVM wrote the article and created tables and figures. AB, PB and GL contributed to data collection. LF, DE, FD, FA, and SD critically reviewed the content of the paper. FD, SD and FA supervised the project. The manuscript was approved by all authors.

Corresponding author

Correspondence to Silvio Danese.

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Ethical statement

The study was approved by Institutional Review Board.

Conflict of interest

FV Mandarino, A Barchi, P Biamonte, L Fanti, D Esposito, G Lauri, F Azzolini, and F D’Amico declare no conflict of interest. S Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor.

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Mandarino, F.V., Barchi, A., Fanti, L. et al. Endoscopic vacuum therapy for post-esophagectomy anastomotic dehiscence as rescue treatment: a single center case series. Esophagus 19, 417–425 (2022). https://doi.org/10.1007/s10388-022-00912-x

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  • DOI: https://doi.org/10.1007/s10388-022-00912-x

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