Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy

Abstract

Background: Intrathoracic anastomotic leakage (IAL) remains a major complication of esophagectomy.Main non-surgical options of management include chest drainage and endoscope interventions. This study is aim to present our experience and assess the efficacy of endoscopic naso-leakage drainage (ENLD) in patients with IAL. Methods: From June 2011 to January 2017, 67 patients who developed IAL after esophagectomy and managed by non-surgical approaches were analyzed retrospectively. IAL was confirmed by clinical presentations combined with the evidence of CT scan, radiography and endoscopy. Thirty-eight patients were treated by conventional chest drainage (CD group) and 29 patients underwent ENLD with or without chest drainage (ENLD group), while other treatments including enteral nutrition and antibiotics had no difference between the two groups. In ENLD group, a 12 Fr naso-leakage tube was placed through the leakage to the bottom of vomica under ultra-slim electronic gastroscope. The naso-leakage tube was then connected to a gastrointestinal decompression device for drainage and was also used for rinse. When the vomica diminished and the drainage was also clean, the naso-leakage tube could be pulled back gradually. Finally, healing of the leakage was confirmed endoscopically. Clinical records of the two groups were analyzed.Results: In ENLD group, naso-leakage tubes were successfully placed under endoscope in all 29 patients without any procedure-related complications. In CD group, the mortality is 7.9% (three patients) and five patients (13.2%) developed to systemic inflammatory response syndrome (SIRS) due to insufficient drainage.While in ENLD group, there was only one patient (3.4%) developed to SIRS and no death was observed, but the difference was not statistically significant. When compared with the CD group, the ENLD group had a shorter healing course (44.2±18.3 vs. 60.5±27.7 days, P=0.008), duration of antibiotics usage (16.4±7.8 vs.11.8±3.8 days, P<0.001) and duration of fever (4.3±2.2 vs. 9.5±8.6 days, P=0.002). Conclusions: To our initial experience, ENLD is an ideal option with safety and efficacy in management of IAL after esophagectomy.

Duration of one-lung ventilation as a risk factor for postoperative pulmonary complications after McKeown esophagectomy

“…Anastomotic leakage was defined as the disruption of the anastomosis that led to an outflow of the intraluminal content, which is an obvious leak as well as leaks without the presence of any clinical symptoms including occult leaks detected with esophagography followed by a chest CT scan. 15 Recurrent nerve palsy was assessed by laryngoscopy on the day of extubation or postoperative hoarseness. Recurrent nerve palsy was defined as any dysmotility in the vocal cords.…”

Efficacy and analysis of modified “three-tube method” in the treatment of intrathoracic anastomotic leakage after esophagectomy

“…The traditional "three-tube method" uses the chest tube, gastrointestinal decompression tube, and enteral nutrition tube to achieve the purpose of gastrointestinal decompression and enteral nutrition support. However, because the IAL often leads to the formation of the mediastinal abscess, the intraoperative chest tube is often fixed between the 6th or 7th intercostal space of the midaxillary line or posterior axillary line, which makes it difficult for the chest tube to reach the position of the fistula, leading to poor drainage (10,11). In the modified "three-tube method", in addition to the traditional chest tube drainage, naso-leakage tube for mediastinal abscess drainage, and in the process of placing the naso-leakage tube, the abscess suction and irrigation under the endoscope for the removal pus and necrotic tissue are very helpful and can significantly reduce systemic inflammatory response (10).…”

Contralateral Spontaneous Rupture of the Esophagus Following severe Vomiting After Non-intubated Pulmonary Wedge Resection

“…The patient declined a timely surgical intervention for personal reasons; therefore, conservative procedures including pleural evacuation, antibiotics and tube feeding were administered. Endoscopy-guided naso-leakage drainage insertion was performed as reported [7], with the aim to rinse the vomica effectively. The healing of the esophageal perforation was recorded 40 days after the treatment (Fig.…”