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Thorac Cardiovasc Surg 2019; 67(07): 597-602
DOI: 10.1055/s-0038-1667320
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Analysis of Endoscopy Intervention in Postesophagectomy Anastomotic Leak: A Retrospective Study

Han Ma
1   Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
,
Jun Wang
1   Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
,
Qinhua Xi
2   Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Jiangsu, China
,
Dongtao Shi
2   Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Jiangsu, China
,
Shiying Zheng
1   Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
,
Haitao Ma
1   Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
,
Jinfeng Ge
1   Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
› Author Affiliations
Further Information

Publication History

03 May 2018

21 June 2018

Publication Date:
02 August 2018 (online)

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Abstract

Background Anastomotic leak after esophagectomy is one of the most challenging complications resulting in a high morbidity and mortality and prolonged hospitalization. The aim of this retrospective study was to access the impact of endoscopy intervention in anastomotic leak.

Methods A retrospective review was conducted at our hospital from January 2008 to December 2016. In total, 263 patients who were diagnosed with an anastomotic leak after esophagectomy and underwent endoscopy examination were included in this study. First, all patients were divided into two groups based on a single criteria—whether they received endoscopy intervention or not—and comparisons were conducted between the two groups. Second, we categorized all patients into three groups based on the diameter of the anastomotic leak (group I: <5 mm; group II: 5–15 mm; group III: >15 mm). Detailed analyses were made for each group. Factors we considered included demographic factors, the length of postoperative hospital stay, the amount of medical expenditure, limited days of oral intake, and the incurrence of complications. Data relating to those factors were collected and then analyzed using standard statistic tools.

Results In general, the difference between endoscopy intervention and conservative measure was significant. Moreover, the hospital stay (p < 0.001; p = 0.018), medical expenditure (p < 0.001; p = 0.003), limited days of oral intake (p < 0.001; p = 0.019), and postoperative complications such as hemorrhage (p < 0.001; p = 0.036), tracheoesophageal fistula (p = 0.002; p = 0.017), and anastomosis stricture (p = 0.03; p = 0.026) were significantly lower among patients who received endoscopy intervention in groups II and III. However, no significant difference was identified between endoscopy intervention and conservative measure in group I.

Conclusions Endoscopy intervention is safe and effective in the diagnosis and treatment of postesophagectomy anastomotic leak. Especially for patients with a diameter of anastomotic leaks greater than 5 mm, the advantages of endoscopy intervention should not be neglected.

Keywords

esophageal surgery - quality of life - surgery - complications
 

  • References

  • 1 Herbella FA, Patti MG. Minimally invasive esophagectomy. World J Gastroenterol 2010; 16 (30) 3811-3815
    CrossrefPubMedGoogle Scholar
  • 2 Courrech Staal EF, Aleman BMP, Boot H, van Velthuysen ML, van Tinteren H, van Sandick JW. Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer. Br J Surg 2010; 97 (10) 1482-1496
    CrossrefPubMedGoogle Scholar
  • 3 Low DE, Kuppusamy MK, Alderson D. , et al. Benchmarking complications associated with esophagectomy. Ann Surg 2017; (e-pub ahead of print) DOI: 10.1097/SLA.0000000000002611.
    CrossrefPubMedGoogle Scholar
  • 4 Struecker B, Andreou A, Chopra S. , et al. Evaluation of anastomotic leak after esophagectomy for esophageal cancer: typical time point of occurrence, mode of diagnosis, value of routine radiocontrast agent studies and therapeutic options. Dig Surg 2017; (e-pub ahead of print) DOI: 10.1159/000480357.
    CrossrefPubMedGoogle Scholar
  • 5 Schlottmann F, Molena D. Anastomotic leak: an early complication with potentially long-term consequences. J Thorac Dis 2016; 8 (10) E1219-E1220
    CrossrefPubMedGoogle Scholar
  • 6 Booka E, Takeuchi H, Nishi T. , et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine (Baltimore) 2015; 94 (33) e1369
    PubMedGoogle Scholar
  • 7 Ott K, Bader FG, Lordick F, Feith M, Bartels H, Siewert JR. Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patients at an experienced center. Ann Surg Oncol 2009; 16 (04) 1017-1025
    CrossrefPubMedGoogle Scholar
  • 8 Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, van Raemdonck D. Anastomotic complications after esophagectomy. Dig Surg 2002; 19 (02) 92-98
    CrossrefPubMedGoogle Scholar
  • 9 Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004; 10 (02) 71-75
    Google Scholar
  • 10 Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. 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 (01) 3-7
    CrossrefPubMedGoogle Scholar
  • 11 Al-issa MA, Petersen TI, Taha AY, Shehatha JS. The role of esophageal stent placement in the management of postesophagectomy anastomotic leak. Saudi J Gastroenterol 2014; 20 (01) 39-42
    CrossrefPubMedGoogle Scholar
  • 12 Park JK, Kim JJ, Moon SW. C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis. J Thorac Dis 2017; 9 (10) 3693-3702
    CrossrefPubMedGoogle Scholar
  • 13 Raju GS, Tarcin O. Endoscopic management of anastomotic esophageal leaks. Tech Gastrointest Endosc 2006; 8: 66-71
    CrossrefPubMedGoogle Scholar
  • 14 Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H. Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc 2000; 51 (01) 73-76
    CrossrefPubMedGoogle Scholar
  • 15 Marjanovic G, Hopt UT. Physiology of anastomotic healing [in German]. Chirurg 2011; 82 (01) 41-47
    CrossrefPubMedGoogle Scholar
  • 16 Rijcken E, Sachs L, Fuchs T, Spiegel HU, Neumann PA. Growth factors and gastrointestinal anastomotic healing. J Surg Res 2014; 187 (01) 202-210
    CrossrefPubMedGoogle Scholar
  • 17 Raman V, Moodie KL, Ofoche OO, Kaiser LR, Erkmen CP. Endoscopy after esophagectomy: safety demonstrated in a porcine model. J Thorac Cardiovasc Surg 2017; 154 (03) 1152-1158
    CrossrefPubMedGoogle Scholar
  • 18 Turkyilmaz A, Eroglu A, Aydin Y, Tekinbas C, Muharrem Erol M, Karaoglanoglu N. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus 2009; 22 (02) 119-126
    CrossrefPubMedGoogle Scholar
  • 19 Manta R, Magno L, Conigliaro R. , et al. Endoscopic repair of post-surgical gastrointestinal complications. Dig Liver Dis 2013; 45 (11) 879-885
    CrossrefPubMedGoogle Scholar
  • 20 Bhat YM, Banerjee S, Barth BA. , et al; ASGE Technology Committee. Tissue adhesives: cyanoacrylate glue and fibrin sealant. Gastrointest Endosc 2013; 78 (02) 209-215
    CrossrefPubMedGoogle Scholar
  • 21 López J, Rodriguez K, Targarona EM. , et al. Systematic review of cyanoacrylate embolization for refractory gastrointestinal fistulae: a promising therapy. Surg Innov 2015; 22 (01) 88-96
    CrossrefPubMedGoogle Scholar
  • 22 Böhm G, Mossdorf A, Klink C. , et al. Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue. Endoscopy 2010; 42 (07) 599-602
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Freeman RK, Vyverberg A, Ascioti AJ. Esophageal stent placement for the treatment of acute intrathoracic anastomotic leak after esophagectomy. Ann Thorac Surg 2011; 92 (01) 204-208 , discussion 208
    CrossrefPubMedGoogle Scholar
  • 24 Schweigert M, Solymosi N, Dubecz A. , et al. Endoscopic stent insertion for anastomotic leakage following oesophagectomy. Ann R Coll Surg Engl 2013; 95 (01) 43-47
    PubMedGoogle Scholar
  • 25 Feith M, Gillen S, Schuster T, Theisen J, Friess H, Gertler R. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol 2011; 9 (03) 202-210
    CrossrefPubMedGoogle Scholar
  • 26 Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc 2016; 30 (06) 2473-2480
    CrossrefPubMedGoogle Scholar
  • 27 Möschler O, Müller MK. Endoluminal vacuum therapy for iatrogenic perforation of the proximal oesophagus. Z Gastroenterol 2014; 52 (03) 281-284
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Heits N, Stapel L, Reichert B. , et al. Endoscopic endoluminal vacuum therapy in esophageal perforation. Ann Thorac Surg 2014; 97 (03) 1029-1035
    CrossrefPubMedGoogle Scholar
  • 29 Pines G, Bar I, Elami A. , et al. Modified endoscopic vacuum therapy for nonhealing esophageal anastomotic leak: technique description and review of literature. J Laparoendosc Adv Surg Tech A 2018; 28 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 30 Laukoetter MG, Mennigen R, Neumann PA. , et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc 2017; 31 (06) 2687-2696
    CrossrefPubMedGoogle Scholar