Abstract
Background: Endoluminal vacuum therapy (EVT) for the management of anastomotic leak (AL) following esophagectomy conventionally uses a sponge applied to vacuum suction. This typically requires exchanges under a general anaesthetic (GA) every 3-5 days and may use self-made adaptations or commercially available devices. We report our experience of a novel EVT system using an endoscopically placed fenestrated surgical drain with applied vacuum suction. We aimed to see whether this was effective, safe, and reduced the frequency of endoscopic exchanges under GA.
Methods: A retrospective study was conducted between August 2019 and March 2023 at a tertiary hospital in the United Kingdom. Patients included had undergone esophagectomy for Esophageal cancer and had developed AL following the procedure which was managed primarily using EVT with drain. The primary outcomes assessed were complete healing of the AL and 90-day mortality.
Results: 20 patients met inclusion criteria. 18 out of 20 patients (90%) achieved full healing of the AL, with two patients declining further EVT due to discomfort. There were no serious adverse events associated with EVT and no patients underwent reoperation for anastomotic revision. The 90-day mortality was 0% and the median duration of EVT was 19.5 days (range 5-72). The median duration between drain repositioning was 7 days (range 2-19), 56% of which were performed without GA.
Conclusions: EVT with drain may be a safe and effective technique for management of AL after esophagectomy. EVT with drain can be performed without GA and permits a longer interval duration between endoscopic device repositioning procedures than similar approaches where an endosponge device is utilised. The benefits of this approach compared to alternative AL management strategies are numerous including reducing the need for frequent endoscopic device exchanges under GA and reduced material cost given the same drain can be used for the duration of therapy.
Methods: A retrospective study was conducted between August 2019 and March 2023 at a tertiary hospital in the United Kingdom. Patients included had undergone esophagectomy for Esophageal cancer and had developed AL following the procedure which was managed primarily using EVT with drain. The primary outcomes assessed were complete healing of the AL and 90-day mortality.
Results: 20 patients met inclusion criteria. 18 out of 20 patients (90%) achieved full healing of the AL, with two patients declining further EVT due to discomfort. There were no serious adverse events associated with EVT and no patients underwent reoperation for anastomotic revision. The 90-day mortality was 0% and the median duration of EVT was 19.5 days (range 5-72). The median duration between drain repositioning was 7 days (range 2-19), 56% of which were performed without GA.
Conclusions: EVT with drain may be a safe and effective technique for management of AL after esophagectomy. EVT with drain can be performed without GA and permits a longer interval duration between endoscopic device repositioning procedures than similar approaches where an endosponge device is utilised. The benefits of this approach compared to alternative AL management strategies are numerous including reducing the need for frequent endoscopic device exchanges under GA and reduced material cost given the same drain can be used for the duration of therapy.
| Original language | English |
|---|---|
| Journal | Annals of Esophagus |
| Volume | 7 |
| Early online date | 14 Mar 2024 |
| DOIs | |
| Publication status | Published - Mar 2024 |
Keywords
- anastomotic leak (AL)
- endoluminal vacuum therapy (EVT)
- esophageal cancer
- Esophagectomy
