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DOI: 10.1055/s-0029-1244150
© Georg Thieme Verlag KG Stuttgart · New York
Endoluminal vacuum therapy for anastomotic insufficiency after gastrectomy
Ingo WallstabeMD
Department of Gastroenterology and Hepatology
Klinikum St. Georg
Delitzscher Str. 141
04129 Leipzig
Germany
Fax: +49-341-9092673
Email: wallstabe@endoskopieren.de
Publication History
Publication Date:
16 June 2010 (online)
The reported incidence of anastomotic leaks is between 5 % and 25 %. Depending on the position and dimensions of the leaks, they are associated with a mortality of up to 60 % [1]. So far endoluminal vacuum therapy has mainly been used for treatment of anastomotic insufficiencies of the rectum [2]. Its use in the esophagus was first reported in 2007 and in only three more cases since then [3] [4] [5].
Here we report a case of a 67-year-old man who developed an anastomotic insufficiency following gastrectomy. Postoperatively, the patient presented a severely septic clinical picture and therefore surgical revision was impossible. He was ventilated and given antibiotics. On endoscopic examination 7 days after gastrectomy, a 1-cm leak covering 30 % of the anastomotic circumference was noted, with an abdominal fistula. We started endoluminal vacuum therapy by endoscopic insertion of the Endo-SPONGE system (B. Braun Melsungen AG, Melsungen, Germany; [Fig. 1]) into the esophagus. The Endo-SPONGE is an open-pored polyurethane sponge. Before insertion, we adjusted its size according to the local topography of the esophagus ([Fig. 2]). The sponge was placed via an overtube into the region of the anastomotic insufficiency at the distal end of the esophagus ([Fig. 3]). The suction tube was extended with a nasogastric tube and secretions were continuously evacuated with a suction of 13.3 kPa. Following daily suction of 200 – 400 mL of secretions, the patient's condition improved remarkably within a few days. We carried out the procedure for a total of 18 days, changing the Endo-SPONGE system every second or third day. The abdominal fistula underwent marked reduction and the anastomotic area epithelialized ([Fig. 4]). The leak was no longer detectable on radiographs and the patient recovered completely.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 1 The Endo-SPONGE system: the sponge and drain.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 2 Adjusting the sponge size.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl3a.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl3b.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 3 Endoscopic views at the start of the treatment showing: a the anastomotic leak; and b the abdominal cavity, seen through the fistula.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl4a.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl4b.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 4 View at completion of endoluminal vacuum therapy: a epithelialization of the abdominal fistula; and b the closed anastomotic leak.
In summary, endoluminal vacuum therapy offers an alternative method for the treatment of complicated anastomotic insufficiency following esophageal or gastric surgery.
Competing interests: None
Endoscopy_UCTN_Code_TTT_1AO_2AI
#References
- 1 Messmann H, Schmidbaur W, Jäckle J. et al . Endoscopic and surgical management of leakage and mediastinitis after esophageal surgery. Best Pract Res Clin Gastroenterol. 2004; 18 809-827
- 2 Weidenhagen R, Grützner K U, Kopp R. et al . Role of vacuum therapy in the management of the septic abdomen. Zentralbl Chir. 2006; 131 115-119
- 3 Wallstabe I, Weimann A. Eine neue endoskopische Technik im Management der Anastomoseninsuffizienz nach Ösophaguschirurgie. Z Gastroenterol. 2007; 45 K14
- 4 Wedemeyer J, Schneider A, Manns M P. et al . Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc. 2008; 67 708-711
- 5 Loske G, Müller C. Vacuum therapy of an esophageal anastomotic leakage-a case report. Zentralbl Chir. 2009; 134 267-270
Ingo WallstabeMD
Department of Gastroenterology and Hepatology
Klinikum St. Georg
Delitzscher Str. 141
04129 Leipzig
Germany
Fax: +49-341-9092673
Email: wallstabe@endoskopieren.de
References
- 1 Messmann H, Schmidbaur W, Jäckle J. et al . Endoscopic and surgical management of leakage and mediastinitis after esophageal surgery. Best Pract Res Clin Gastroenterol. 2004; 18 809-827
- 2 Weidenhagen R, Grützner K U, Kopp R. et al . Role of vacuum therapy in the management of the septic abdomen. Zentralbl Chir. 2006; 131 115-119
- 3 Wallstabe I, Weimann A. Eine neue endoskopische Technik im Management der Anastomoseninsuffizienz nach Ösophaguschirurgie. Z Gastroenterol. 2007; 45 K14
- 4 Wedemeyer J, Schneider A, Manns M P. et al . Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc. 2008; 67 708-711
- 5 Loske G, Müller C. Vacuum therapy of an esophageal anastomotic leakage-a case report. Zentralbl Chir. 2009; 134 267-270
Ingo WallstabeMD
Department of Gastroenterology and Hepatology
Klinikum St. Georg
Delitzscher Str. 141
04129 Leipzig
Germany
Fax: +49-341-9092673
Email: wallstabe@endoskopieren.de
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 1 The Endo-SPONGE system: the sponge and drain.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 2 Adjusting the sponge size.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl3a.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl3b.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 3 Endoscopic views at the start of the treatment showing: a the anastomotic leak; and b the abdominal cavity, seen through the fistula.
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl4a.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2010S02/thumbnails/793cl4b.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Fig. 4 View at completion of endoluminal vacuum therapy: a epithelialization of the abdominal fistula; and b the closed anastomotic leak.