Effectiveness of endoscopic vacuum therapy as rescue treatment in refractory leaks after gastro-esophageal surgery
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ORIGINAL ARTICLE
Effectiveness of endoscopic vacuum therapy as rescue treatment in refractory leaks after gastro‑esophageal surgery Carlo Alberto De Pasqual1 · Valentina Mengardo1 · Francesco Tomba2 · Alessandro Veltri1 · Michele Sacco1 · Simone Giacopuzzi1 · Jacopo Weindelmayer1 · Giovanni de Manzoni1 Received: 11 September 2020 / Accepted: 15 November 2020 © The Author(s) 2020
Abstract The treatment of leak after esophageal and gastric surgery is a major challenge. Over the last few years, endoscopic vacuum therapy (E-VAC) has gained popularity in the management of this life-threatening complication. We reported our initial experience on E-VAC therapy as rescue treatment in refractory anastomotic leak and perforation after gastro-esophageal surgery. From September 2017 to December 2019, a total of 8 E-VAC therapies were placed as secondary treatment in 7 patients. Six for anastomotic leak (3 cervical, 1 thoracic, 2 abdominal) and 1 for perforation of the gastric conduit. In 6 cases, E-VAC was placed intracavitary; while in the remaining 2, the sponge was positioned intraluminal (one patient was treated with both approaches). A total of 60 sponges were used in the whole cohort. The median number of sponge insertions was 10 (range: 5–14) with a median treatment duration of 41 days (range: 19–49). A complete healing was achieved in 4 intracavitary (67%) and in 1 intraluminal (50%) E-VAC. We observed only one E-VAC-related complication: a bleeding successfully managed endoscopically. E-VAC therapy seems to be a safe and effective tool in the management of leaks and perforations after upper GI surgery, although with longer healing time when it is used as secondary treatment. Keywords E-VAC · Refractory anastomotic leak · Upper-GI surgery
Introduction Anastomotic leak is one of the most feared complication after upper gastro-intestinal (UGI) surgery, with an incidence ranging between 5 and 30% and an associated mortality of 20–50% [1, 2]. Optimal treatment of the leak requires cleaning of the abscess and avoidance of further contamination through the digestive tract. Therapeutic strategies range from reoperation to percutaneous drain placement and endoscopic stent placement [3]. Endoscopic stent placement is, nowadays, the preferred procedure in stable patients, but it is burdened by a significant risk of complications (perforation, bleeding and stent migration) [3, 4]. Moreover, after the stent * Valentina Mengardo [email protected] 1
General and Upper GI Surgery Division, University of Verona, Piazzale A. Stefani 1, 37124 Verona, Italy
Department of Emergency Surgical Endoscopy, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37124 Verona, Italy
2
is placed, an additional percutaneous drain is often necessary to drain the excluded abscess [5]. Endoscopic vacuum therapy (E-VAC) has emerged over the last few years as an alternative to treat leak and perforations. First introduced in 2003 for the management of anastomotic leak after rectal surgery [6], its use has been succ
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