Surgical Endoscopy

, Volume 27, Issue 6, pp 2040–2045 | Cite as

Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus

  • Tobias Schorsch
  • Christian Müller
  • Gunnar LoskeEmail author



The management of anastomotic leakage and iatrogenic esophageal perforation has shifted over recent decades from aggressive surgery to conservative and, recently, endoscopic therapy alternatives. The authors present their results for endoscopic vacuum therapy used to treat both entities.


In the authors’ institution, 17 cases of anastomotic leakage and 7 cases of iatrogenic perforation due to interventional endoscopy or rigid panendoscopy with either intraluminal or intracavitary endoscopic vacuum therapy were treated.


In 23 of 24 cases, the endoscopic treatment was successful. The median duration of therapy was 11 days (range, 4–46 days). All 7 cases of iatrogenic perforation and 16 of 17 anastomotic leakage cases were cured after a median therapy duration of 5 and 12 days, respectively.


Endoscopic vacuum therapy is applicable for a wide range of esophageal defects. In the authors’ experience, it has seemed to be the best choice for iatrogenic perforations and has been a potent supplement in the management of anastomotic leakages.


Anastomotic leakage Anastomosis Perforation Esophageal Esophagus Endoscopy Vacuum therapy Complication 



Gunnar Loske and Christian Mueller received honoraria for organizing and performing a workshop dealing with vacuum therapy for anastomotic dehiscence after resections in the upper and lower gastrointestinal tract by BBD Aesculap. Gunnar Loske received a grant from Aesculap AG and Olympus Europa Holding GmbH regarding endoscopic vacuum therapy.

Conflict of interest

Tobias Schorsch has no conflicts of interest or financial ties to disclose.


  1. 1.
    Hermansson M, Johansson J, Gudbjartsson T, Hambreus G, Jonsson P, Lillo-Gil R, Smedh U, Zilling T (2010) Esophageal perforation in South of Sweden: results of surgical treatment in 125 consecutive patients. BMC Surg 10:31PubMedCrossRefGoogle Scholar
  2. 2.
    Nederlof N, Tilanus HW, Tran TC, Hop WC, Wijnhoven BP, de Jonge J (2011) End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg 254:226–233PubMedCrossRefGoogle Scholar
  3. 3.
    Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10:71–75PubMedGoogle Scholar
  4. 4.
    Holscher AH, Schroder W, Bollschweiler E, Beckurts KT, Schneider PM (2003) How safe is high intrathoracic esophagogastrostomy? Chirurg 74:726–733PubMedCrossRefGoogle Scholar
  5. 5.
    Sepesi B, Raymond DP, Peters JH (2010) Esophageal perforation: surgical, endoscopic, and medical management strategies. Curr Opin Gastroenterol 26:379–383PubMedCrossRefGoogle Scholar
  6. 6.
    Vallbohmer D, Holscher AH, Holscher M, Bludau M, Gutschow C, Stippel D, Bollschweiler E, Schroder W (2009) Options in the management of esophageal perforation: analysis over a 12-year period. Dis Esophagus 23:185–190PubMedCrossRefGoogle Scholar
  7. 7.
    Vogel SB, Rout WR, Martin TD, Abbitt PL (2005) Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 241:1016–1021PubMedCrossRefGoogle Scholar
  8. 8.
    Schubert D, Pross M, Nestler G, Ptok H, Scheidbach H, Fahlke J, Lippert H (2006) Endoscopic treatment of mediastinal anastomotic leaks. Zentralbl Chir 131:369–375PubMedCrossRefGoogle Scholar
  9. 9.
    Kirschniak A, Subotova N, Zieker D, Konigsrainer A, Kratt T (2011) The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc 25:2901–2905PubMedCrossRefGoogle Scholar
  10. 10.
    Loske G, Schorsch T, Muller C (2010) Endoscopic vacuum sponge therapy for esophageal defects. Surg Endosc 24:2531–2535PubMedCrossRefGoogle Scholar
  11. 11.
    Loske GSTMC (2011) Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy 43:540–544PubMedCrossRefGoogle Scholar
  12. 12.
    Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2008) Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 22:1818–1825PubMedCrossRefGoogle Scholar
  13. 13.
    Schmidt SC, Strauch S, Rosch T, Veltzke-Schlieker W, Jonas S, Pratschke J, Weidemann H, Neuhaus P, Schumacher G (2010) Management of esophageal perforations. Surg Endosc 24:2809–2813PubMedCrossRefGoogle Scholar
  14. 14.
    Fritscher-Ravens A, Hampe J, Grange P, Holland C, Olagbeye F, Milla P, von Herbay A, Jacobsen B, Seehusen F, Hadeler KG, Mannur K (2010) Clip closure versus endoscopic suturing versus thoracoscopic repair of an iatrogenic esophageal perforation: a randomized, comparative, long-term survival study in a porcine model (with videos). Gastrointest Endosc 72:1020–1026PubMedCrossRefGoogle Scholar
  15. 15.
    Ahrens M, Schulte T, Egberts J, Schafmayer C, Hampe J, Fritscher-Ravens A, Broering DC, Schniewind B (2010) Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study. Endoscopy 42:693–698PubMedCrossRefGoogle Scholar
  16. 16.
    Page RD, Shackcloth MJ, Russell GN, Pennefather SH (2005) Surgical treatment of anastomotic leaks after esophagectomy. Eur J Cardiothorac Surg 27:337–343PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Tobias Schorsch
    • 1
  • Christian Müller
    • 1
  • Gunnar Loske
    • 1
    Email author
  1. 1.Department for General, Abdominal, Thoracic, and Vascular SurgeryKatholisches Marienkrankenhaus Hamburg gGmbHHamburgGermany

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