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

Abstract

Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the “gold standard” for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. Methods: A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. Results: Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43–4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08–6.71), shorter treatment duration (pmd −9.18, 95% CI −17.05- −1.32), lower short-term complication (OR 0.35, 95% CI 0.18–0.71) and mortality rates (OR 0.47, 95% CI 0.24–0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74–3.40, I2 = 0%). Conclusions: Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks.

Anastomotic Leakage after Gastrectomy for Gastric Cancer

“…A meta-analysis including four retrospective studies with esophagectomy and gastrectomy for oncologic reasons including 164 patients compared the EVT to stenting showed the same success rate (OR=1.59) and the same duration of hospitalization, but lower number of devices in SEMS group and lower short-term complication rate in EVT group (OR=0.25) [93]. Another meta-analysis including 559 patients with gastrectomy and esophagectomy proved 81% closure defect for EVT and 65% for SEMS, with lower mortality for EVT patients, although many confounders were encountered in the selected studies [94].…”

Microbiota profiling in esophageal diseases: Novel insights into molecular staining and clinical outcomes

“…Its development is influenced by chronic inflammation and environmental and genetic factors, but its etiology and pathogenesis are not fully understood yet [112] . Growing evidence shows that the human microbiota plays a vital role in EC carcinogenesis [113] . The two main histological subtypes of EC, esophageal squamous cell carcinoma (ESCC) and EAC account for the majority of cases [111] .…”

“…Advancements in surgical techniques have certainly improved patient outcomes, but the incidence of post-esophagectomy leaks remains high, ranging between 11.4% and 21.2% [110] , [111] . Treatment strategies vary depending on the patient’s clinical status and time of presentation and may involve endoscopy, such as Endoscopic Vacuum Therapy (EVT) or esophageal stent placement [112] , [113] , [114] , [115] , [116] , [117] , [118] , or surgical reintervention. The high prevalence of anastomotic leaks highlights the need for a better understanding of the factors contributing to these complications and potential strategies for prevention and management.…”

Vacuum stent: a game-changer in endoscopic multistep management of leakage following bariatric surgery

“…Apart from surgical repair, various endoscopic treatment options have been explored such as placement of self-expandable metal stents (SEMSs) 2 . Recently, endoscopic vacuum therapy (EVT) has become a valid alternative owing to a clinical success rate of up to 95%, shorter treatment duration, and lower mortality rate 3 . However, intraluminal EVT in the upper gastrointestinal tract prevents early enteral nutrition.…”