Endoscopy 2010; 42(9): 693-698
DOI: 10.1055/s-0030-1255688
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study

M.  Ahrens1 [*] , T.  Schulte1 [*] , J.  Egberts1 , C.  Schafmayer1 , J.  Hampe2 , A.  Fritscher-Ravens2 , 3 , D.  C.  Broering1 , B.  Schniewind1
  • 1Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
  • 2Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
  • 3Homerton University Hospital, London, United Kingdom
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Publikationsverlauf

submitted 15 November 2009

accepted after revision 09 June 2010

Publikationsdatum:
30. August 2010 (online)

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Background and study aims: Major leakage from an esophageal anastomosis is a life-threatening surgical complication. Endoscopically guided endoluminal vacuum therapy using polyurethane sponges is a new method for treating such leakage.

Patients and methods: Between June 2007 and June 2009, five patients (mean age 68 years) who developed anastomotic leakage after esophageal surgery were prospectively evaluated. After endoscopic diagnosis of a major leakage, polyurethane sponges were endoscopically positioned in the wound cavity of the anastomosis. Continuous suction was applied via drainage tubes fixed to the sponges. Initially sponges were endoscopically changed three times per week.

Results: In all five patients treatment was successful. Median time to reduce levels of inflammation markers by 50 % was 10 days for white blood cell (WBC) count and 7 days for C-reactive protein (CRP). The smallest initial wound cavity size was 42 cm3 and the largest was 157 cm3. The median duration of drainage was 28 days, with a median of 9 sponge changes and a median time to total cavity closure of 42 days. Two patients needed anastomotic dilation by Savary-Miller bougienage due to stenosis found on further follow-up. One of these patients died of acute severe hemorrhage from an aortoanastomotic fistula after the dilation procedure.

Conclusions: Endoscopically assisted vacuum therapy is a well-tolerated and effective therapeutic option for treatment of major esophageal leaks after surgery. Additional surgery was avoided in all cases. However, the occurrence of a delayed aortoesophageal fistula calls for careful further investigation of this new technique.

References

1 M. A. and T. S. contributed equally to this work.

B. SchniewindMD 

University Hospital of Schleswig-Holstein, Campus Kiel
Clinic for General and Thoracic Surgery

Arnold-Heller-Strasse 3 (Haus 18)
D-24105 Kiel
Germany

Fax: +49-431-597-4586

eMail: bodo.schniewind@uksh-kiel.de