Endoscopy 2020; 52(S 01): S312
DOI: 10.1055/s-0040-1705061
ESGE Days 2020 ePoster presentations
Thursday, April 23, 2020 09:00 – 17:00 Endoscopic technology ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC INTERNAL DRAINAGE VS. LOW NEGATIVE PRESSURE ENDOLUMINAL VACUUM THERAPY FOR LEAKAGES AFTER ONCOLOGIC UPPER GASTROINTESTINAL SURGERY

CFM Jung
1   University Medical Center Göttingen, Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
,
A Müller-Dornieden
2   University Medical Center Göttingen, Department of General, Visceral and Pediatric Surgery, Göttingen, Germany
,
R Hallit
3   Hôpital Cochin, University Paris Descartes, Department of Gastroenterology and Gastrointestinal Oncology, Paris, France
,
M Calmels
4   St Louis University Hospital, Assistance Publique Hôpitaux de Paris and University of Paris, Digestive Surgery Department, Paris, France
,
U Chaput
5   St Antoine University Hospital, Assistance Publique Hôpitaux de Paris and Sorbonne Paris Cité University, Gastroenterology Department, Paris, France
,
X Dray
5   St Antoine University Hospital, Assistance Publique Hôpitaux de Paris and Sorbonne Paris Cité University, Gastroenterology Department, Paris, France
,
JM Gonzalez
6    North Hospital, Assistance Publique – Hôpitaux de Marseille and University of Aix-Marseille, Gastroenterology Department, Marseille, France
,
M Barthet
6    North Hospital, Assistance Publique – Hôpitaux de Marseille and University of Aix-Marseille, Gastroenterology Department, Marseille, France
,
J Jacques
7   Limoges University Hospital, and University Limoges, Gastroenterology Department, Limoges, France
,
R Legros
7   Limoges University Hospital, and University Limoges, Gastroenterology Department, Limoges, France
,
D Goere
4   St Louis University Hospital, Assistance Publique Hôpitaux de Paris and University of Paris, Digestive Surgery Department, Paris, France
,
J Gaedcke
2   University Medical Center Göttingen, Department of General, Visceral and Pediatric Surgery, Göttingen, Germany
,
M Ghadimi
2   University Medical Center Göttingen, Department of General, Visceral and Pediatric Surgery, Göttingen, Germany
,
S Kunsch
1   University Medical Center Göttingen, Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
,
Volker Ellenrieder
1   University Medical Center Göttingen, Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
,
S Chaussade
3   Hôpital Cochin, University Paris Descartes, Department of Gastroenterology and Gastrointestinal Oncology, Paris, France
,
E Wedi
1   University Medical Center Göttingen, Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
,
M Barret
3   Hôpital Cochin, University Paris Descartes, Department of Gastroenterology and Gastrointestinal Oncology, Paris, France
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Publikationsverlauf

Publikationsdatum:
23. April 2020 (online)

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    Aims Endoscopic internal drainage using pigtail stents (EID) serves as treatment option for leakages after upper GI oncologic surgery. Endoluminal vacuum therapy (EVT) also offers high closure rates and active therapy surveillance. Secretion drainage and mucosal irrigation are mechanisms of action. Both treatments have not been compared in larger studies.

    Methods Between 2016 and 2019, patients treated for postoperative leakages after oncologic upper GI surgery at five reference centers for digestive endoscopy in France(group A) and Göttingen (group B) were included. General patient- and procedure related data were retrospectively analyzed and compared using propensity score matching. Group A was treated with EID, group B received low negative pressure EVT (−20/-50 mmHg). Pigtails were changed every 4 weeks, whereas EVT was repeated every 3–4 days. Besides descriptive analysis, comparison was performed using Fishers exact test and Poisson regression test.

    Results A total of 35 (A) and 27 (B) patients where included. Age (62 ± 8.8y A vs. 66 ± 10y B), Charlson Morbidity score (4 ± 1.1 A vs. 5 ± 2.1 B) and diagnosis after surgery (12 ± 9.8d A vs. 8 ± 8.5d B) were equal in both groups. Type of surgery was Ivor Lewis Esophagectomy in 48.6% (A) and 70.4% (B). Leakage sizes ranged from 5 mm to over 2 cm. Treatment success was higher in group A (n = 35/35) than in group B (23/27; p = 0.03). Less endoscopies were necessary for leak closure in group A when compared to group B (n = 2.5 ± 0.66 A vs. 4.1 ± 3 B; p = 0.008). Esophageal stenoses during follow-up were less frequent after EID (n = 3/35 A) vs. EVT (n = 4/27; p = 0.05).

    Conclusions In this propensity score matched study, EID provides better healing rates and long-term outcome than low negative pressure EVT. EID presents a cost-effective alternative in patients with leakages after oncologic upper GI surgery. Larger studies are needed to confirm these primary results.


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