Endoscopic vacuum therapy for anastomotic leakage after upper gastrointestinal surgery.

Background: Recently, endoscopic vacuum therapy (EVT) was introduced as treatment for anastomotic leakage after upper gastrointestinal (GI) surgery. The aim of this study was to describe the initial experience with EVT for anastomotic leakage after upper GI surgery in a tertiary referral center.
Methods: Patients treated with EVT for anastomotic leakage after upper GI surgery were included retrospectively (January 2018-June 2021) and prospectively (June 2021-October 2021). The primary end point was the EVT success rate. Secondary end points included mortality and adverse events.
Results: 38 patients were included (31 men; mean age 66 years): 27 had undergone an esophagectomy with gastric conduit reconstruction and 11 a total gastrectomy with esophagojejunal anastomosis. EVT was successful in 28 patients (74 %, 95 %CI 57 %-87 %). In 10 patients, EVT failed: deceased owing to radiation pneumonitis (n = 1), EVT-associated complications (n = 2), and defect closure not achieved (n = 7). Mean duration of successful EVT was 33 days, with a median of six EVT-related endoscopies. Median hospital stay was 45 days.
Conclusion: This initial experience with EVT for anastomotic leakage after upper GI surgery demonstrated a success rate of 74 %. EVT is a promising therapy that could prevent further major surgery. More experience with the technique and its indications will likely improve success rates in the future.
Competing Interests: R.E. Pouw is a consultant for MicroTech Europe and Medtronic bv., has received speakerʼs fees from Pentax, and is on the advisory board of EsoCap AG. M.I. van Berge Henegouwen is a consultant for Mylan, Johnson & Johnson, Alesi Surgical, BBraun, and Medtronic, and has received unrestricted research grants from Stryker (all fees paid to the institution). L.M.D. Pattynama, F. Daams, S.S. Gisbertz, J.J.G.H.M. Bergman, and W.J. Eshuis declare that they have no conflict of interest.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)