Download PDF
Endoscopy 2022; 54(01): 71-74
DOI: 10.1055/a-1375-8151
Innovations and brief communications

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

Carlo Felix Maria Jung
 1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
,
Rachel Hallit
 2   Department of Gastroenterology and Gastrointestinal Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
,
Annegret Müller-Dornieden
 3   Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
,
Mélanie Calmels
 4   Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
,
Diane Goere
 4   Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
,
Ulriikka Chaput
 5   Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
,
Marine Camus
 5   Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
,
Jean Michel Gonzalez
 6   Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
,
Marc Barthet 
 6   Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
,
Jérémie Jacques
 7   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Romain Legros
 7   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Thierry Barrioz
 8   Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
,
Fabian Kück
 9   Department of Medical Statistics, University Medical Center, University of Göttingen, Göttingen, Germany
,
Ali Seif Amir Hosseini
10   Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
,
Michael Ghadimi
 3   Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
,
Steffen Kunsch
 1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
,
Volker Ellenrieder
 1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
,
Edris Wedi
 1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
11   Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach, Offenbach, Germany
,
Maximilien Barret 
 2   Department of Gastroenterology and Gastrointestinal Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Referred to by:

Author commentary on Carlo Felix Maria Jung et al.Endoscopy 2022; 54(01): v3-v3
DOI: 10.1055/a-1403-1491

See also:

Endoscopic internal drainage versus endoscopic vacuum therapy for upper gastrointestinal leaks: what's the real deal?Endoscopy 2023; 55(01): 100-100
DOI: 10.1055/a-1888-4116

See also:

Reply to Danese et al.Endoscopy 2023; 55(01): 101-101
DOI: 10.1055/a-1901-8750

Abstract

Background Endoscopic internal drainage (EID) with double-pigtail stents or low negative-pressure endoscopic vacuum therapy (EVT) are treatment options for leakage after upper gastrointestinal oncologic surgery. We aimed to compare the effectiveness of these techniques.

Methods Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtail stents were changed every 4 weeks; EVT was repeated every 3–4 days until leak closure.

Results 35 EID and 27 EVT patients were included, with a median (interquartile range [IQR]) leak size of 0.75 cm (0.5–1.5). Overall treatment success was 100 % (95 % confidence interval [CI] 90 %–100 %) for EID vs. 85.2 % (95 %CI 66.3 %–95.8 %) for EVT (P = 0.03). The median (IQR) number of endoscopic procedures was 2 (2–3) vs. 3 (2–6.5; P = 0.003) and the median (IQR) treatment duration was 42 days (28–60) vs. 17 days (7.5–28; P < 0.001), for EID vs. EVT, respectively.

Conclusion EID and EVT provide high closure rates for upper gastrointestinal anastomotic leaks. EVT provides a shorter treatment duration, at the cost of a higher number of procedures.

Tables 1 s–3 s



Publication History

Received: 30 July 2020

Accepted after revision: 27 January 2021

Accepted Manuscript online:
27 January 2021

Article published online:
08 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rutegard M, Lagergren P, Rouvelas I. et al. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol 2012; 19: 99-103
    CrossrefPubMedGoogle Scholar
  • 2 Rutegard M, Lagergren P, Rouvelas I. et al. Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. Eur J Surg Oncol 2012; 38: 555-561
    CrossrefPubMedGoogle Scholar
  • 3 Blencowe NS, Strong S, McNair AG. et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg 2012; 255: 658-666
    CrossrefPubMedGoogle Scholar
  • 4 Watanabe M, Miyata H, Gotoh M. et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 2014; 260: 1034-1039
    CrossrefPubMedGoogle Scholar
  • 5 Rodrigues-Pinto E, Morais R, Macedo G. et al. Choosing the appropriate endoscopic armamentarium for treatment of anastomotic leaks. Am J Gastroenterol 2019; 114: 367-371
    CrossrefPubMedGoogle Scholar
  • 6 Jung CFM, Muller-Dornieden A, Gaedcke J. et al. Impact of endoscopic vacuum therapy with low negative pressure for esophageal perforations and postoperative anastomotic esophageal leaks. Digestion 2020; DOI: 10.1159/000506101.
    CrossrefPubMedGoogle Scholar
  • 7 Pequignot A, Fuks D, Verhaeghe P. et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy?. Obes Surg 2012; 22: 712-720
    CrossrefPubMedGoogle Scholar
  • 8 Donatelli G, Dumont JL, Cereatti F. et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 2015; 25: 1293-1301
    CrossrefPubMedGoogle Scholar
  • 9 Donatelli G, Dumont JL, Cereatti F. et al. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series. Endosc Int Open 2016; 4: E647-E651
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Loske G, Muller CT. Tips and tricks for endoscopic negative pressure therapy. Chirurg 2019; 90: 7-14
    CrossrefPubMedGoogle Scholar
  • 11 Wedi E, Schuler P, Kunsch S. et al. Individual endoscopic management of anastomotic insufficiency after esophagectomy for esophageal squamous cell carcinoma and creation of a neostomach. Endoscopy 2018; 50: E69-E71
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Bouchard S, Eisendrath P, Toussaint E. et al. Trans-fistulary endoscopic drainage for post-bariatric abdominal collections communicating with the upper gastrointestinal tract. Endoscopy 2016; 48: 809-816
    Article in Thieme ConnectPubMedGoogle Scholar