Endoscopic and surgical management of leakage and mediastinitis after esophageal surgery

Messmann, Helmut; Schmidbaur, W.; Jäckle, Jürgen; Fürst, Alois; Iesalnieks, Igors

doi:10.1016/j.bpg.2004.05.001

Cited by 12 publications

(1 citation statement)

References 70 publications

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“…This complication is associated with a prolonged hospital stay and increased postoperative mortality and therefore one of the most feared complications in visceral surgery [ 1 – 4 ]. During the last years, there has been a controversial debate about the optimal treatment strategy of anastomotic leaks ranging from conservative over interventional endoscopic to surgical approaches [ 4 – 6 ]. While early anastomotic leaks, particularly in the presence of sepsis, as well as extended conduit necrosis still remain a recommended indication for surgical revision, growing expertise suggests endoscopic treatment in the case of leaks, which are defined as localized retentions connected to the site of anastomotic insufficiency [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Tachezy

Rieck

Kantowski

et al. 2021

Trials

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Background Intrathoracic anastomotic leaks represent a major complication after Ivor Lewis esophagectomy. There are two promising endoscopic treatment strategies in the case of leaks: the placement of self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT). Up to date, there is no prospective data concerning the optimal endoscopic treatment strategy. This is a protocol description for the ESOLEAK trial, which is a first small phase 2 randomized trial evaluating the quality of life after treatment of anastomotic leaks by either SEMS placement or EVT. Methods This phase 2 randomized trial will be conducted at two German tertiary medical centers and include a total of 40 patients within 2 years. Adult patients with histologically confirmed esophageal cancer, who have undergone Ivor Lewis esophagectomy and show an esophagogastric anastomotic leak on endoscopy or present with typical clinical signs linked to an anastomotic leak, will be included in our study taking into consideration the exclusion criteria. After endoscopic verification of the anastomotic leak, patients will be randomized in a 1:1 ratio into two treatment groups. The intervention group will receive EVT whereas the control group will be treated with SEMS. The primary endpoint of this study is the subjective quality of life assessed by the patient using a systematic and validated questionnaire (EORTC QLQ C30, EORTC QLQ-OES18 questionnaire). Important secondary endpoints are healing rate, period of hospitalization, treatment-related complications, and overall mortality. Discussion The latest meta-analysis comparing implantation of SEMS with EVT in the treatment of esophageal anastomotic leaks suggested a higher success rate for EVT. The ESOLEAK trial is the first study comparing both treatments in a prospective manner. The aim of the trial is to find suitable endpoints for the treatment of anastomotic leaks as well as to enable an adequate sample size calculation and evaluate the feasibility of future interventional trials. Due to the exploratory design of this pilot study, the sample size is too small to answer the question, whether EVT or SEMS implantation represents the superior treatment strategy. Trial registration ClinicalTrials.gov NCT03962244. Registered on May 23, 2019. DRKS-ID DRKS00007941

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Section: Introductionmentioning

confidence: 99%

Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Tachezy

Rieck

Kantowski

et al. 2021

Trials

View full text Add to dashboard Cite

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Review: Therapeutic Endoscopy for the Treatment of Anastomotic Dehiscences

Arezzo

Verra

Galloro

et al. 2014

Endoscopic Follow-Up of Digestive Anastomosis

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Endoscopic Management of Benign Esophageal Ruptures and Leaks

Leo

Maselli

Ferrara

et al. 2017

Curr Treat Options Gastro

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Esophageal leaks (EL) and ruptures (ER) are rare conditions associated with a high risk of mortality and morbidity. Historically, EL and ER have been surgically treated, but current treatment options also include conservative management and endoscopy. Over the last decades, interventional endoscopy has evolved as an effective and less invasive alternative to primary surgery in these cases. A variety of techniques are currently available to re-establish the continuity of the digestive tract, prevent or treat infection related to the leak/rupture, prevent further contamination, drain potential collections, and provide nutritional support. Endoscopic options include clips, both through the scope (TTS) and over the scope (OTS), stent placement, vacuum therapy, tissue adhesive, and endoscopic suturing techniques. Theoretically, all of these can be used alone or with a multimodality approach. Endoscopic therapy should be combined with medical therapy but also with percutaneous drainage of collections, where present. There is robust evidence suggesting that this change of therapeutic paradigm in the form of endoscopic therapy is associated with improved outcome, better quality of life, and shortened length of hospital stay. Moreover, recent European guidelines on endoscopic management of iatrogenic perforation have strengthened and to some degree regulated and redefined the role of endoscopy in the management of conditions where there is a breach in the continuity of the GI wall. Certainly, due to the complexity of these conditions and the variety of available treatment options, a multidisciplinary approach is strongly recommended, with close clinical monitoring (by endoscopists, surgeons, and intensive care physicians) and special attention to signs of sepsis, which can lead to the need for urgent surgical management. This review article will critically discuss the literature regarding endoscopic modalities for esophageal leak and perforation management and attempt to place them in perspective for the physician.

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Endoscopic and surgical management of leakage and mediastinitis after esophageal surgery

Cited by 12 publications

References 70 publications

Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Review: Therapeutic Endoscopy for the Treatment of Anastomotic Dehiscences

Endoscopic Management of Benign Esophageal Ruptures and Leaks

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