Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30 mm following oncologic Ivor-Lewis esophagectomy: a matched case–control study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Management of anastomotic leaks after Ivor-Lewis esophagectomy remains a challenge. Although intracavitary endoscopic vacuum therapy (EVT) has shown great efficacy for large dehiscences, the optimal management of smaller leaks has not been standardized. This study aims to compare EVT versus self-expandable metal stent (SEMS) in the treatment of leaks < 30 mm in size, due to the lack of current data on this topic.

Methods

Patients undergoing EVT (cases) or SEMS (controls) between May 2017 and July 2022 for anastomotic leaks < 3 cm following oncologic Ivor-Lewis esophagectomy were enrolled. Controls were matched in a 1:1 ratio based on age (± 3 years), BMI (± 3 kg/m2) and leak size (± 4 mm).

Results

Cases (n = 22) and controls (n = 22) showed no difference in baseline characteristics and leak size, as per matching at enrollment. No differences were detected between the two groups in terms of time from surgery to endoscopic treatment (p = 0.11) or total number of procedures per patient (p = 0.05). Remarkably, the two groups showed comparable results in terms of leaks resolution (90.9% vs. 72.7%, p = 0.11). The number of procedures per patient was not significant between the two cohorts (p = 0.05). The most frequent complication in the SEMS group was migration (15.3% of procedures).

Conclusion

EVT and SEMS seem to have similar efficacy outcomes in the treatment of anastomotic defects < 30 mm after Ivor-Lewis esophagectomy. However, larger studies are needed to corroborate these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Article  PubMed  Google Scholar 

  2. Busweiler LA, Wijnhoven BP, van Berge Henegouwen MI, Henneman D, van Grieken NC, Wouters MW, van Hillegersberg R, van Sandick JW, Dutch Upper Gastrointestinal Cancer Audit (DUCA) Group (2016) Early outcomes from the Dutch Upper Gastrointestinal Cancer Audit. Br J Surg 103:1855–1863

    Article  CAS  PubMed  Google Scholar 

  3. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D’Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, Hofstetter W, Jobe B, Kitagawa Y, Law S, Mariette C, Maynard N, Morse CR, Nafteux P, Pera M, Pramesh CS, Puig S, Reynolds JV, Schroeder W, Smithers M, Wijnhoven BPL (2019) Benchmarking complications associated with esophagectomy. Ann Surg 269:291–298

    Article  PubMed  Google Scholar 

  4. Seesing MFJ, Gisbertz SS, Goense L, van Hillegersberg R, Kroon HM, Lagarde SM, Ruurda JP, Slaman AE, van Berge Henegouwen MI, Wijnhoven BPL (2017) A propensity score matched analysis of open versus minimally invasive transthoracic esophagectomy in the Netherlands. Ann Surg 266:839–846

    Article  PubMed  Google Scholar 

  5. Kassis ES, Kosinski AS, Ross P Jr, Koppes KE, Donahue JM, Daniel VC (2013) Predictors of anastomotic leak after esophagectomy: an analysis of the Society of Thoracic Surgeons general thoracic database. Ann Thorac Surg 96:1919–1926

    Article  PubMed  Google Scholar 

  6. Mandarino FV, Esposito D, Spelta GNE, Cavestro GM, Rosati R, Parise P, Gemma MF, Fanti L (2022) Double layer stent for the treatment of leaks and fistula after upper gastrointestinal oncologic surgery: a retrospective study. Updates Surg 74:1055–1062

    Article  PubMed  Google Scholar 

  7. Aryaie AH, Singer JL, Fayezizadeh M, Lash J, Marks JM (2017) Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc 31:612–617

    Article  PubMed  Google Scholar 

  8. Zhang CC, Liesenfeld L, Klotz R, Koschny R, Rupp C, Schmidt T, Diener MK, Müller-Stich BP, Hackert T, Sauer P, Büchler MW, Schaible A (2021) Feasibility, effectiveness, and safety of endoscopic vacuum therapy for intrathoracic anastomotic leakage following transthoracic esophageal resection. BMC Gastroenterol 21:72

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Chon SH, Brunner S, Müller DT, Lorenz F, Stier R, Streller L, Eckhoff J, Straatman J, Babic B, Schiffmann LM, Schröder W, Schmidt T, Bruns CJ, Fuchs HF (2022) Time to endoscopic vacuum therapy—lessons learned after > 150 robotic-assisted minimally invasive esophagectomies (RAMIE) at a German high-volume center. Surg Endosc 37:741–748

    Article  PubMed  PubMed Central  Google Scholar 

  10. Min YW, Kim T, Lee H, Min BH, Kim HK, Choi YS, Lee JH, Rhee PL, Kim JJ, Zo JI, Shim YM (2019) Endoscopic vacuum therapy for postoperative esophageal leak. BMC Surg 19:37

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chon SH, Berlth F, Dratsch T, Plum PS, Lorenz F, Goeser T, Bruns CJ (2022) Outcome of prophylactic endoscopic vacuum therapy for high-risk anastomosis after esophagectomy. Minim Invasive Ther Allied Technol 31:1079–1085

    Article  PubMed  Google Scholar 

  12. Mandarino FV, Barchi A, Biamonte P, Esposito D, Azzolini F, Fanti L, Danese S (2022) The prophylactic use of endoscopic vacuum therapy for anastomotic dehiscence after rectal anterior resection: is it feasible for redo surgery? Tech Coloproctol 26:319–320

    Article  CAS  PubMed  Google Scholar 

  13. Loske G, Schorsch T, Müller C (2011) Intraluminal and intracavitary vacuum therapy for esophageal leakage: a new endoscopic minimally invasive approach. Endoscopy 43:540–544

    Article  CAS  PubMed  Google Scholar 

  14. Reimer S, Lock JF, Flemming S, Weich A, Widder A, Plaßmeier L, Döring A, Hering I, Hankir MK, Meining A, Germer CT, Groneberg K, Seyfried F (2022) Endoscopic management of large leakages after upper gastrointestinal surgery. Front Surg 9:885244

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mandarino FV, Barchi A, Fanti L, D'Amico F, Azzolini F, Esposito D, Biamonte P, Lauri G, Danese S (2022) Endoscopic vacuum therapy for post-esophagectomy anastomotic dehiscence as rescue treatment: a single center case series. Esophagus 19:417–425. https://doi.org/10.1007/s10388-022-00912-x

    Article  PubMed  Google Scholar 

  16. Brangewitz M, Voigtländer T, Helfritz FA, Lankisch TO, Winkler M, Klempnauer J, Manns MP, Schneider AS, Wedemeyer J (2013) Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy 45:433–438

    Article  CAS  PubMed  Google Scholar 

  17. Hwang JJ, Jeong YS, Park YS, Yoon H, Shin CM, Kim N, Lee DH (2016) Comparison of endoscopic vacuum therapy and endoscopic stent implantation with self-expandable metal stent in treating postsurgical gastroesophageal leakage. Medicine 95:e3416

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Berlth F, Bludau M, Plum PS, Herbold T, Christ H, Alakus H, Kleinert R, Bruns CJ, Hölscher AH, Chon SH (2019) Self-expanding metal stents versus endoscopic vacuum therapy in anastomotic leak treatment after oncologic gastroesophageal surgery. J Gastrointest Surg 23:67–75

    Article  PubMed  Google Scholar 

  19. Mennigen R, Harting C, Lindner K, Vowinkel T, Rijcken E, Palmes D, Senninger N, Laukoetter MG (2015) Comparison of endoscopic vacuum therapy versus stent for anastomotic leak after esophagectomy. J Gastrointest Surg 19:1229–1235

    Article  PubMed  Google Scholar 

  20. El-Sourani N, Miftode S, Bockhorn M, Arlt A, Meinhardt C (2022) Endoscopic management of anastomotic leakage after esophageal surgery: ten year analysis in a tertiary university center. Clin Endosc 55:58–66

    Article  PubMed  Google Scholar 

  21. Senne M, Werner CR, Schempf U, Thiel K, Königsrainer A, Wichmann D (2022) Comparison of two endoscopic therapeutic interventions as primary treatment for anastomotic leakages after total gastrectomy. Cancers 14:2982

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Eichelmann AK, Ismail S, Merten J, Slepecka P, Palmes D, Laukötter MG, Pascher A, Mardin WA (2021) Economic burden of endoscopic vacuum therapy compared to alternative therapy methods in patients with anastomotic leakage after esophagectomy. J Gastrointest Surg 25:2447–2454

    Article  PubMed  PubMed Central  Google Scholar 

  23. Schniewind B, Schafmayer C, Voehrs G, Egberts J, von Schoenfels W, Rose T, Kurdow R, Arlt A, Ellrichmann M, Jürgensen C, Schreiber S, Becker T, Hampe J (2013) Endoscopic endoluminal vacuum therapy is superior to other regimens in managing anastomotic leakage after esophagectomy: a comparative retrospective study. Surg Endosc 27:3883–3890

    Article  PubMed  Google Scholar 

  24. Low DE, Alderson D, Cecconello I, Chang AC, Darling GE, D’Journo XB, Griffin SM, Hölscher AH, Hofstetter WL, Jobe BA, Kitagawa Y, Kucharczuk JC, Law SY, Lerut TE, Maynard N, Pera M, Peters JH, Pramesh CS, Reynolds JV, Smithers BM, van Lanschot JJ (2015) International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 262:286–294

    Article  PubMed  Google Scholar 

  25. Li H, Zhuang S, Yan H, Wei W, Su Q (2021) Risk factors of anastomotic leakage after esophagectomy with intrathoracic anastomosis. Front Surg 8:743266

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hagens ERC, Reijntjes MA, Anderegg MCJ, Eshuis WJ, van Berge Henegouwen MI, Gisbertz SS (2021) Risk factors and consequences of anastomotic leakage after esophagectomy for cancer. Ann Thorac Surg 112:255–263

    Article  PubMed  Google Scholar 

  27. Pournaras DJ, Hardwick RH, Safranek PM, Sujendran V, Bennett J, Macaulay GD, Hindmarsh A (2018) Endoluminal vacuum therapy (E-Vac): a treatment option in oesophagogastric surgery. World J Surg 42:2507–2511

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. van den Berg MW, Kerbert AC, van Soest EJ, Schwartz MP, Bakker CM, Gilissen LP, van Hooft JE (2016) Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula. Dis Esophagus 29:572–579

    Article  PubMed  Google Scholar 

  29. Anderloni A, Genco C, Massidda M, Di Leo M, Fumagalli UR, Rosati R, Correale L, Maselli R, Ferrara EC, Jovani M, Repici A (2019) Self-expanding metal stents for the treatment of post-surgical esophageal leaks: a tertiary referral center experience. Dig Surg 36:309–316

    Article  PubMed  Google Scholar 

  30. Scognamiglio P, Reeh M, Melling N (2022) Management of intra-thoracic anastomotic leakages after esophagectomy: updated systematic review and meta-analysis of endoscopic vacuum therapy versus stenting. BMC Surg 22:309

    Article  PubMed  PubMed Central  Google Scholar 

  31. Scognamiglio P, Reeh M, Melling N, Kantowski M, Eichelmann AK, Chon SH, El-Sourani N, Schön G, Höller A, Izbicki JR, Tachezy M (2020) Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis. Endoscopy 52:632–642

    Article  PubMed  Google Scholar 

  32. Rausa E, Asti E, Aiolfi A, Bianco F, Bonitta G, Bonavina L (2018) Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis. Dis Esophagus. https://doi.org/10.1093/dote/doy060

    Article  PubMed  Google Scholar 

  33. Mandarino FV, Barchi A, D’Amico F, Fanti L, Azzolini F, Viale E, Esposito D, Rosati R, Fiorino G, Bemelman WA, Elmore U, Barbieri L, Puccetti F, Testoni SGG, Danese S (2023) Endoscopic vacuum therapy (EVT) versus self-expandable metal stent (SEMS) for anastomotic leaks after upper gastrointestinal surgery: systematic review and meta-analysis. Life (Basel) 13:287

    PubMed  Google Scholar 

  34. Jung DH, Huh CW, Min YW, Park JC (2022) Endoscopic vacuum therapy for the management of upper GI leaks and perforations: a multicenter retrospective study of factors associated with treatment failure (with video). Gastrointest Endosc 95:281–290

    Article  PubMed  Google Scholar 

  35. Tachezy M, Chon SH, Rieck I, Kantowski M, Christ H, Karstens K, Gebauer F, Goeser T, Rösch T, Izbicki JR, Bruns CJ (2021) Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial. Trials 22:377

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Francesco Vito Mandarino and Alberto Barchi have contributed equally to the work.

Authors and Affiliations

  1. Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Francesco Vito Mandarino, Alberto Barchi, Lorenzo Leone, Lorella Fanti, Francesco Azzolini, Edi Viale, Dario Esposito & Silvio Danese

  2. Department of Gynecology/Obstetrics Unit, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Noemi Salmeri

  3. Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy

    Francesco Puccetti, Lavinia Barbieri, Andrea Cossu, Elio Treppiedi, Ugo Elmore & Riccardo Rosati

Authors
  1. Francesco Vito Mandarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Barchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorella Fanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Azzolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edi Viale
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dario Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Noemi Salmeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Puccetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lavinia Barbieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andrea Cossu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Elio Treppiedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ugo Elmore
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Riccardo Rosati
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Silvio Danese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Vito Mandarino.

Ethics declarations

Disclosures

Prof. Silvio 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, Millennium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor. The other authors declare no conflict of interests. Dr. Francesco Vito Mandarino, Dr. Alberto Barchi, Dr. Lorenzo Leone, Dr. Lorella Fanti, Dr. Francesco Azzolini, Dr. Edi Viale, Dr. Dario Esposito, Dr. Noemi Salmeri, Dr. Francesco Puccetti, Dr. Lavinia Barbieri, Dr. Andrea Cossu, Dr. Elio Treppiedi, Dr. Ugo Elmore and Prof. Riccardo Rosati have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mandarino, F.V., Barchi, A., Leone, L. et al. Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30 mm following oncologic Ivor-Lewis esophagectomy: a matched case–control study. Surg Endosc 37, 7039–7050 (2023). https://doi.org/10.1007/s00464-023-10213-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10213-8

Keywords

Search

Navigation