Comparison of Two Endoscopic Therapeutic Interventions as Primary Treatment for Anastomotic Leakages after Total Gastrectomy

Abstract

Introduction: An esophagojejunal anastomotic leak following an oncological gastrectomy is a life-threatening complication, and its management is challenging. A stent application and endoscopic negative pressure therapy are possible therapeutic options. A clinical comparison of these strategies has been missing until now. Methods: A retrospective analysis of 14 consecutive patients endoscopically treated for an anastomotic leak after a gastrectomy between June 2014 and December 2019 was performed. Results: The mean time of the diagnosis of the leakage was 7.14 days after surgery. Five patients were selected for a covered stent, and nine patients received endoscopic negative pressure therapy. In the stent group, the mean number of endoscopies was 2.4, the mean duration of therapy was 26 days, and the mean time of hospitalization was 30 days. In patients treated with endoscopic negative pressure therapy, the mean number of endoscopies was 6.0, the mean days of therapy duration was 14.78, and the mean days of hospitalization was 38.11. Treatment was successful in all patients in the stent-based therapy group and in eight of nine patients in the negative pressure therapy group. Discussion: Good clinical results in preserving the anastomosis and providing sepsis control was achieved in all patients. Stent therapy resulted in anastomosis healing with a lower number of endoscopies, a shorter time of hospitalization, and rapid oral nutrition.

Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis

“…In contrast, the subgroup analysis revealed no statistically significant differences in the success rate between EVT and stenting, with substantially lower heterogeneity (I 2 = 0% versus I 2 = 11%). These data are in line with most studies included in the analysis [ 21 , 22 , 23 , 24 , 25 , 28 ], as only Brangewitz et al [ 26 ] and Mennigen et al [ 27 ] revealed higher efficacy of EVT compared to the stent group. However, the non-uniform definition of success, generically described as the resolution of symptoms or radiological/endoscopic healing, could represent an important methodological issue in this analysis ( Table 2 ).…”

“…Sixty-three reports were assessed for eligibility and 55 were excluded as follows: Non-comparative studies (n 45), comparison studies with other treatments (n 7), unfulfilling data (n 2), and non-human studies (n 1). A total of eight retrospective studies were considered eligible for quantitative synthesis [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”

“…According to the NOS criteria, six studies [ 21 , 22 , 23 , 24 , 26 , 27 ] were assessed as fair quality with a moderate risk of bias, while the other two studies were evaluated as poor quality [ 25 , 28 ]. Details are shown in Supplementary Table S3 .…”

“…Overall, EVT showed a higher success rate compared to stenting (OR 2.58, 95% CI 1.43–4.66). All studies revealed the superior efficacy of EVT, except for Senne et al, which reported better results for esophageal stenting [ 24 ].…”

“…In this subgroup analysis, in four studies [ 21 , 22 , 23 , 24 ], EVT and stent revealed no significant differences in the success rate (OR 1.59, 95% CI 0.74–3.40), showing insignificant heterogeneity (I 2 = 0%) The duration of hospitalization was no different for the two techniques (pooled mean difference 7.98, 95% CI −3.39–19.36) (moderate heterogeneity, I 2 = 52%)…”