Endoscopic internal drainage and low negative-pressure endoscopic vacuum therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Jung, Carlo; Hallit, Rabih; Müller-Dornieden, Annegret; Calmels, Mélanie; Goèré, Diane; Chaput, Ulriikka; Camus, Marine; Gonzalez, Jean Michel; Barthet, Marc; Jacques, Jérémie; Legros, Romain; Barrioz, Thierry; Kück, Fabian; Hosseini, Ali; Ghadimi, Michael; Kunsch, Steffen; Ellenrieder, Volker; Wedi, Edris; Barret, Maximilien

doi:10.1055/a-1375-8151

Cited by 23 publications

(21 citation statements)

References 12 publications

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“…18,19 Compared to endoluminal vacuum therapy, patients with EID can generally commence oral feeding earlier, EID procedures can be performed without a general anesthetic, and there is less need for frequent and repeated endoscopic procedures. [21][22][23] Nine out of 12 patients (75%) were successfully managed with EID using DPT in this case series. DPT allows for early oral nutritional feeding and potentially avoids conventional external drainage.…”

Section: Discussionmentioning

confidence: 75%

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

et al. 2022

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Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining ten patients, nine (90%) did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the first week and a soft diet in the second week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

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Section: Discussionmentioning

confidence: 75%

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

et al. 2022

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“…Morykwas et al showed in a porcine model that an effective increase of wound blood flow was reached at a negative pressure of − 125 mmHg, which lead to optimal oxygenation, neoangiogenisis and elaboration of growth factors and consequently to a faster tissue granulation [33]. Contrary to this, Jung et al presented a clinical trial in which they achieved a sealing rate of 78.3% in an AL subgroup analysis for the mono-therapy of EVT with a pressure between − 20 and − 50 mmHg [34]. We have used − 125 mmHg since we introduced this treatment option in our clinic [14].…”

Section: Discussionmentioning

confidence: 99%

Time to endoscopic vacuum therapy—lessons learned after > 150 robotic-assisted minimally invasive esophagectomies (RAMIE) at a German high-volume center

et al. 2022

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Objective of the study In esophageal surgery, anastomotic leak (AL) remains one of the most severe and critical adverse events after oncological esophagectomy. Endoscopic vacuum therapy (EVT) can be used to treat AL; however, in the current literature, treatment outcomes and reports on how to use this novel technique are scarce. The aim of this study was to evaluate the outcomes of patients with an AL after IL RAMIE and to determine whether using EVT as an treatment option is safe and feasible. Material and methods This study includes all patients who developed an Esophagectomy Complications Consensus Group (ECCG) type II AL after IL RAMIE at our center between April 2017 and December 2021. The analysis focuses on time to EVT, duration of EVT, and follow up treatments for these patients. Results A total of 157 patients underwent an IL RAMIE at our hospital. 21 patients of these (13.4%) developed an ECCG type II AL. One patient died of unrelated Covid-19 pneumonia and was excluded from the study cohort. The mean duration of EVT was 12 days (range 4–28 days), with a mean of two sponge changes (range 0–5 changes). AL was diagnosed at a mean of 8 days post-surgery (range 2–16 days). Closure of the AL with EVT was successful in 15 out of 20 patients (75%). Placement of a SEMS (Self-expandlable metallic stent) after EVT was performed in four patients due to persisting AL. Overall success rate of anastomotic sealing independently of the treatment modality was achieved in 19 out of 20 Patients (95%). No severe EVT-related adverse events occurred. Conclusion This study shows that EVT can be a safe and effective endoscopic treatment option for ECCG type II AL.

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“…A study by Jung et al Comparing EID vs. EVT in defects after oncologic surgery confirmed high healing success after EID with 100% vs. 85.2% after EVT [ 99 ].…”

Section: Endoscopic Techniquesmentioning

confidence: 99%

Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review

et al. 2023

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Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.

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Endoscopic internal drainage and low negative-pressure endoscopic vacuum therapy for anastomotic leaks after oncologic upper gastrointestinal surgery

Cited by 23 publications

References 12 publications

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

Time to endoscopic vacuum therapy—lessons learned after > 150 robotic-assisted minimally invasive esophagectomies (RAMIE) at a German high-volume center

Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review

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