Endoscopy 2010; 42(7): 595-598
DOI: 10.1055/s-0030-1255518
Case report/series

© Georg Thieme Verlag KG Stuttgart · New York

Use of a NOTES closure device for full-thickness suturing of a postoperative anastomotic esophageal leakage

J.  Hampe1 [*] , B.  Schniewind2 [*] , M.  Both3 , A.  Fritscher-Ravens1
  • 1Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
  • 2Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
  • 3Department of Radiology, University Hospital Schleswig-Holstein, Kiel, Germany
Further Information

Publication History

submitted 17 February 2010

accepted after revision 15 April 2010

Publication Date:
30 June 2010 (online)

Leakages at surgical anastomoses in the gastrointestinal tract represent a challenging clinical problem. Standard therapy entails conservative or surgical revision of the anastomotic area with high morbidity and mortality up to 30 %. None of the previous endoscopic approaches, which include stenting, endoscopic clip closure, and fibrin glue injection, are sufficiently established for routine clinical use. We report a case of a 68-year-old woman with a postoperative leakage and abscess at the esophagojejunostomy. The defect was closed with two anchor-lock sutures. The patient was able to resume oral food intake 5 days later and made a full recovery with endoscopically documented mucosal healing at the site of the anastomosis. In summary, endoscopic suturing may be a promising approach for the treatment of postoperative leaks that warrants further, controlled investigation.

References

  • 1 Junemann-Ramirez M, Awan M Y, Khan Z M, Rahamim J S. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre.  Eur J Cardiothorac Surg. 2005;  27 3-7
  • 2 Whooley B P, Law S, Murthy S C. et al . Analysis of reduced death and complication rates after esophageal resection.  Ann Surg. 2001;  233 338-344
  • 3 Khan A Z, Nikolopolous I, Botha A J, Mason R C. Substernal long segment left colon interposition for oesophageal replacement.  Surgeon. 2008;  6 54-56
  • 4 Parekh K, Iannettoni M D. Complications of esophageal resection and reconstruction.  Seminars in thoracic and cardiovascular surgery. 2007;  19 79-88
  • 5 Mariette C, Piessen G, Balon J M. et al . Surgery alone in the curative treatment of localised oesophageal carcinoma.  Eur J Surg Oncol. 2004;  30 869-876
  • 6 Mariette C, Taillier G, Van Seuningen I, Triboulet J P. Factors affecting postoperative course and survival after en bloc resection for esophageal carcinoma.  Ann Thorac Surg. 2004;  78 1177-1183
  • 7 Matory Y L, Burt M. Esophagogastrectomy: reoperation for complications.  J Surg Oncol. 1993;  54 29-33
  • 8 Pennathur A, Luketich J D. Resection for esophageal cancer: strategies for optimal management.  Ann Thorac Surg. 2008;  85 751-756
  • 9 Rodella L, Laterza E, De Manzoni G. et al . Endoscopic clipping of anastomotic leakages in esophagogastric surgery.  Endoscopy. 1998;  30 453-456
  • 10 Infante M, Valente M, Andreani S. et al . Conservative management of esophageal leaks by transluminal endoscopic drainage of the mediastinum or pleural space.  Surgery. 1996;  119 46-50
  • 11 Adler D G, McAfee M, Gostout C J. Closure of an esophagopleural fistula by using fistula tract coagulation and an endoscopic suturing device.  Gastrointest Endosc. 2001;  54 652-653
  • 12 Roy-Choudhury S H, Nicholson A A, Wedgwood K R. et al . Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents.  AJR Am J Roentgenol. 2001;  176 161-165
  • 13 Doniec J M, Schniewind B, Kahlke V. et al . Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy.  Endoscopy. 2003;  35 652-658
  • 14 Tuebergen D, Rijcken E, Mennigen R. et al . Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations.  J Gastrointest Surg. 2008;  12 1168-1176
  • 15 Peters J H, Craanen M E, van der Peet D L. et al . Self-expanding metal stents for the treatment of intrathoracic esophageal anastomotic leaks following esophagectomy.  Am J Gastroenterol. 2006;  101 1393-1395
  • 16 Page R D, Shackcloth M J, Russell G N, Pennefather S H. Surgical treatment of anastomotic leaks after oesophagectomy.  Eur J Cardiothorac Surg. 2005;  27 337-343
  • 17 Truong S, Bohm G, Klinge U. et al . Results after endoscopic treatment of postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue.  Surg Endosc. 2004;  18 1105-1108
  • 18 Landen S, El Nakadi I. Minimally invasive approach to Boerhaave’s syndrome: a pilot study of three cases.  Surg Endosc. 2002;  16 1354-1357
  • 19 Fritscher-Ravens A, Cuming T, Jacobsen B. et al . Feasibility and safety of endoscopic full-thickness esophageal wall resection and defect closure: a prospective long-term survival animal study.  Gastrointest Endosc. 2009;  69 1314-1320
  • 20 Raju G S, Fritscher-Ravens A, Rothstein R I. et al . Endoscopic closure of colon perforation compared to surgery in a porcine model: a randomized controlled trial (with videos).  Gastrointest Endosc. 2008;  68 324-332
  • 21 Ikeda K, Fritscher-Ravens A, Mosse C A. et al . Endoscopic full-thickness resection with sutured closure in a porcine model.  Gastrointest Endosc. 2005;  62 122-129
  • 22 Fritscher-Ravens A, Patel K, Ghanbari A. et al . Natural orifice transluminal endoscopic surgery (NOTES) in the mediastinum: long-term survival animal experiments in transesophageal access, including minor surgical procedures.  Endoscopy. 2007;  39 870-875

1 J.H. and B.S. contributed equally to this paper.

A. Fritscher-RavensMD 

Department of Internal Medicine I
University Hospital Schleswig-Holstein, Campus Kiel

Schittenhelmstrasse 12
24105 Kiel
Germany

Fax: +49-431-5971302

Email: fri.rav@btopenworld.com