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Brito M, Nunes G, Luz C, Oliveira G, Pinto Marques P, Fonseca J. Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks. GE Port J Gastroenterol 2023; 30:45-51. [PMID: 37818399 PMCID: PMC10561319 DOI: 10.1159/000524420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/08/2022] [Indexed: 10/12/2023]
Abstract
Introduction Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL.Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.
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Affiliation(s)
- Mariana Brito
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC – Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal
| | - Gonçalo Nunes
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC – Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal
| | - Carlos Luz
- Department of Surgery, Hospital Garcia de Orta, Almada, Portugal
| | - Gabriel Oliveira
- Department of Surgery, Hospital Garcia de Orta, Almada, Portugal
| | | | - Jorge Fonseca
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC – Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal
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Kouladouros K. Applications of endoscopic vacuum therapy in the upper gastrointestinal tract. World J Gastrointest Endosc 2023; 15:420-433. [PMID: 37397978 PMCID: PMC10308278 DOI: 10.4253/wjge.v15.i6.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the treatment of anastomotic leaks after esophageal and gastric surgery, it was also implemented for a wide range of defects, including acute perforations, duodenal lesions, and postbariatric complications. Apart from the initially proposed handmade sponge inserted using the “piggyback” technique, further devices were used, such as the commercially available EsoSponge and VAC-Stent as well as open-pore film drainage. The reported pressure settings and intervals between the subsequent endoscopic procedures vary greatly, but all available evidence highlights the efficacy of EVT, with high success rates and low morbidity and mortality, so that in many centers it is considered to be a first-line treatment, especially for anastomotic leaks.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Surgical Clinic, Mannheim University Hospital, University of Heidelberg, Mannheim 68167, Baden-Wuerttemberg, Germany
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3
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Lubbers M, van Det MJ, Crull D, van der Linden A, Vrij AA, Kouwenhoven EA. Suction Drainage for Anastomotic Leakage After Ivor Lewis Esophagectomy. Surg Laparosc Endosc Percutan Tech 2023; 33:31-6. [PMID: 36730429 DOI: 10.1097/SLE.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anastomotic leakage is one of the most life-threatening complications after Ivor Lewis esophagectomy (ILE), with various treatment strategies. Endoscopic techniques are emerging as a less invasive alternative to surgery. Among the current endoscopic techniques, a single placement of an endoluminal nasogastric tube inside the cavity with controlled suction drainage (SD) seems to be an attractive option. The aim of this study was to evaluate the efficacy of SD as treatment for anastomotic leakage after ILE. METHODS This retrospective analysis was performed among patients who underwent ILE in a high-volume esophageal cancer center in the Netherlands. Patients with an anastomotic leakage that received SD as primary treatment were selected. A nasogastric tube was endoscopically placed into the cavity of the leakage for controlled suction with 15 mm Hg. RESULTS A total of 34 patients received SD and was successful in 26 patients (77%). Seven patients (21%) developed empyema despite the SD for which additional video-assisted thoracoscopic surgery was performed. Mortality was 5.9% (2 patients) and median intensive care unit and hospital stay were 3 days (1 to 9) and 25 days (14 to 43), respectively. The median time to closure of the leak was 41 days (23 to 65). A total of 16 patients underwent home treatment for a median of 23 (14 to 42) days. CONCLUSIONS Controlled SD seems to be an effective treatment for anastomotic leakage after ILE. This therapy can safely and effectively be completed in an ambulant, outpatient setting.
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Simas de Lima M, Uemura RS, Gusmon-Oliveira CC, Pombo AADM, Martins BC, Lenz L, Kawaguti FS, De Paulo GA, Baba ER, Safatle-Ribeiro AV, Ribeiro U, Monkemüller K, Maluf-Filho F. Tube-in-tube endoscopic vacuum therapy for the closure of upper gastrointestinal fistulas, leaks, and perforations. Endoscopy 2022; 54:980-986. [PMID: 35378562 DOI: 10.1055/a-1774-4630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND : Although endoscopic vacuum therapy (EVT) has been successfully used to treat postoperative upper gastrointestinal (UGI) wall defects, its use demands special materials and several endoscopic treatment sessions. Herein, we propose a technical modification of EVT using a double tube (tube-in-tube drain) without polyurethane sponges for the drainage element. The tube-in-tube drainage device enables irrigation and application of suction. A flowchart for standardizing the management of postoperative UGI wall defects with this device is presented. METHODS : An EVT modification was made to achieve frequent fistula cleansing, with 3 % hydrogen peroxide rinsing, and the application of negative pressure. A tube-in-tube drain without polyurethane sponges can be inserted like a nasogastric tube or passed through a previously positioned surgical drain. This was a retrospective two-center observational study, with data collected from 30 consecutive patients. Technical success, clinical success, adverse events, time under therapy, interval time from procedure to fistula diagnosis and treatment start, size of transmural defect, volume of cavity, number of endoscopic treatment sessions, and mortality were reviewed. RESULTS : 30 patients with UGI wall defects were treated. The technical and clinical success rates were 100 % and 86.7 %, respectively. Three patients (10 %) had adverse events and three patients (10 %) died. The median time under therapy was of 19 days (range 1-70) and the median number of endoscopic sessions was 3 (range 1-9). CONCLUSIONS : This standardized approach and EVT modification using a tube-in-tube drain, with frequent fistula cleansing, were successful and safe in a wide variety of UGI wall defects.
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Affiliation(s)
- Marcelo Simas de Lima
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Sato Uemura
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla Cristina Gusmon-Oliveira
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Amanda Aquino de Miranda Pombo
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Costa Martins
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciano Lenz
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fabio Shiguehissa Kawaguti
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gustavo Andrade De Paulo
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Elisa Ryoka Baba
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Adriana V Safatle-Ribeiro
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Klaus Monkemüller
- Division of Gastroenterology, University Teaching Hospital Ameos Klinikum, Halberstadt, Germany
| | - Fauze Maluf-Filho
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Huang J, Tian L, Wang B. Predictive value of postoperative serum prealbumin levels for early detection of anastomotic leak after esophagectomy: A retrospective study. Medicine (Baltimore) 2022; 101:e29201. [PMID: 35512077 PMCID: PMC9276443 DOI: 10.1097/md.0000000000029201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/11/2022] [Indexed: 01/04/2023] Open
Abstract
The impact of serum prealbumin in patients with esophageal carcinoma after undergoing esophagectomy remains unclear, we speculated that serum prealbumin is associated with anastomotic leak (AL) after surgery, low serum prealbumin level may lead to AL. The aim of the study was to evaluate the relationship between serum prealbumin levels and AL after esophagectomy, to explore the value of serum prealbumin as an early predictor of AL after esophagectomy.Between January 2014 and December 2018, 255 patients were enrolled in this study, their basic characteristics and perioperative serum prealbumin levels were retrospectively analyzed. Statistical analysis by t test, nonparametric test and logistic regression were used to analyze data for patients with and without AL. Based on a receiver operator characteristic curve, a cut-off value for serum prealbumin levels as a predictor of AL was determined.Among the 255 patients, 18 patients were diagnosed with AL. The overall AL rate was 7.0% (18/255) including 12 cases of intrathoracic AL and 6 cases of cervical AL. By univariate analysis, we identified postoperative serum prealbumin level as a risk factor for AL (P < .001). Multivariate analysis also demonstrated postoperative serum prealbumin level (P = .028) to be an independent risk factor for AL. The best cut-off value of postoperative serum prealbumin level was 131 mg/L for predicting AL, with 83.3% sensitivity and 72.2% specificity.Postoperative serum prealbumin level was significantly associated with AL. it may help the early prediction of postoperative AL.
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Hou N, Xu X, Lv D, Lu Y, Li J, Cui P, Ma R, Luo X, Tang Y, Zheng Y. Tissue-engineered esophagus: recellular esophageal extracellular matrix based on perfusion-decellularized technique and mesenchymal stem cells. Biomed Mater 2021; 16. [PMID: 34384057 DOI: 10.1088/1748-605x/ac1d3d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Perfusion-decellularization was an interesting technique to generate a natural extracellular matrix (ECM) with the complete three-dimensional anatomical structure and vascular system. In this study, the esophageal ECM (E-ECM) scaffold was successfully constructed by perfusion-decellularized technique through the vascular system for the first time. And the physicochemical and biological properties of the E-ECM scaffolds were evaluated. The bone marrow mesenchymal stem cells (BMSCs) were induced to differentiate into myocytesin vitro. E-ECM scaffolds reseeded with myocytes were implanted into the greater omenta to obtain recellular esophageal ECM (RE-ECM), a tissue-engineered esophagus. The results showed that the cells of the esophagi were completely and uniformly removed after perfusion. E-ECM scaffolds retained the original four-layer organizational structure and vascular system with excellent biocompatibility. And the E-ECM scaffolds had no significant difference in mechanical properties comparing with fresh esophagi,p> 0.05. Immunocytochemistry showed positive expression ofα-sarcomeric actin, suggesting that BMSCs had successfully differentiated into myocytes. Most importantly, we found that in the RE-ECM muscularis, the myocytes regenerated linearly and continuously and migrated to the deep, and the tissue vascularization was obvious. The cell survival rates at 1 week and 2 weeks were 98.5 ± 3.0% and 96.4 ± 4.6%, respectively. It was demonstrated that myocytes maintained the ability for proliferation and differentiation for at least 2 weeks, and the cell activity was satisfactory in the RE-ECM. It follows that the tissue-engineered esophagus based on perfusion-decellularized technique and mesenchymal stem cells has great potential in esophageal repair. It is proposed as a promising alternative for reconstruction of esophageal defects in the future.
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Affiliation(s)
- Nan Hou
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaoli Xu
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China.,Department of Otorhinolaryngology, University-Town Hospital, Chongqing Medical University, Chongqing Municipality, People's Republic of China
| | - Die Lv
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Yanqing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Jingzhi Li
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Pengcheng Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Chinese People's Liberation Army Air Force Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Ruina Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Chinese People's Liberation Army Air Force Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Xiaoming Luo
- Department of Biomedical Science, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Ying Tang
- Department of Pathology, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Yun Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Kong FW, Wang WM, Liu L, Wu WB, Gong LB, Zhang M. Late-onset anastomotic leak following sweet esophagectomy: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e22479. [PMID: 33019440 PMCID: PMC7535676 DOI: 10.1097/md.0000000000022479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Late-onset anastomotic leak (AL) is an uncommon but potentially lethal complication after esophagectomy. PATIENT CONCERNS A 74-year-old male patient was readmitted due to chest distress and chills about 3 months after initial esophagectomy for cancer. DIAGNOSES The previous endoscopic biopsy revealed primary esophageal squamous cell carcinoma, and sweet esophagectomy with gastric conduit reconstruction was therefore performed. The patient developed AL 3 months after the surgery. INTERVENTIONS Naso-leakage extraluminal drainage tube was utilized because the symptoms of the patient were aggravated 1 month after the chest tube drainage since his second admission for AL. OUTCOMES Twenty-one days after naso-leakage extraluminal drainage, the computed tomography images showed the healing of the leakage. Then the patient was discharged from the hospital. LESSONS Late-onset AL should be kept in mind when the patient complained of chest distress and fever during the follow up after esophagectomy. In addition, naso-leakage extraluminal drainage could be considered for the treatment of AL. Further trials for better evidence are warranted.
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Affiliation(s)
- Feng-Wei Kong
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou
| | - Wei-Min Wang
- Department of General Surgery, Xuzhou Infectious Disease Hospital, Xuzhou
| | - Lei Liu
- Department of Gastroenterology of Yichang Central People's Hospital, Institute of Digestive Disease, China Three Gorges University, Yichang
| | - Wen-Bin Wu
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Long-Bo Gong
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Miao Zhang
- Department of Surgery, Xuzhou Central Hospital, Xuzhou, China
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Verstegen MHP, Bouwense SAW, van Workum F, Ten Broek R, Siersema PD, Rovers M, Rosman C. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J Emerg Surg 2019; 14:17. [PMID: 30988695 PMCID: PMC6449949 DOI: 10.1186/s13017-019-0235-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/14/2019] [Indexed: 01/28/2023] Open
Abstract
Background Anastomotic leakage (0-30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature. Methods A systematic literature search was performed in Medline, Embase, and Web of Science until April 2017. All studies reporting on the specific treatment of cervical or intrathoracic anastomotic leakage following esophagectomy with gastric tube reconstruction for esophageal or cardia cancer were included. The primary outcome parameter was postoperative mortality. Methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Results Nineteen retrospective cohort studies including 273 patients were identified. Methodological quality of all studies was poor to moderate. Mortality rates of intrathoracic anastomotic leakages in the treatment groups were as follows: conservative (14%), endoscopic stent (8%), endoscopic drainage (8%), endoscopic vacuum-assisted closure system (0%), and surgery treatment group (50%). Mortality rates of cervical anastomotic leakages in the treatment groups were as follows: conservative (8%), endoscopic stent (29%), and endoscopic dilatation (0%). Discussion Due to small cohorts, heterogeneity between studies, and lack of data regarding leakage characteristics, no evidence supporting a specific treatment for anastomotic leakage after esophagectomy was found. A severity score based on leakage characteristics instead of treatment given is essential for determining the optimal treatment of anastomotic leakage. In the absence of robust evidence-based treatment guidelines, we suggest customized treatment depending on sequelae of the leak and clinical condition of the patient. PrDepartment of Surgery, Radboudumc, P.O.B. 9101/618 NLactical advices are provided. Trial registration Registration number PROSPERO: CRD42016032374.
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Affiliation(s)
- Moniek H P Verstegen
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Stefan A W Bouwense
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Frans van Workum
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Richard Ten Broek
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Peter D Siersema
- 2Gastroenterology and Hepatology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Maroeska Rovers
- 3Operating Rooms and Health Evidence, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Camiel Rosman
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Abstract
Anastomotic leakage (AL) is one of the most critical and detrimental complications in esophageal surgery. Early diagnosis and timely therapeutic action are necessary if patients are to avoid AL-related problems. However, there is no gold standard or consensus for early diagnosis. In this review, we focus on summarizing the definition and types of AL and modalities for early diagnosis of AL after esophagectomy.
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Affiliation(s)
- Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Suwon, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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10
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Huang J, Zhou Y, Wang C, Yuan W, Zhang Z, Chen B, Zhang X. Logistic regression analysis of the risk factors of anastomotic fistula after radical resection of esophageal-cardiac cancer. Thorac Cancer 2017; 8:666-671. [PMID: 28940985 PMCID: PMC5668517 DOI: 10.1111/1759-7714.12509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/13/2017] [Accepted: 08/13/2017] [Indexed: 12/25/2022] Open
Abstract
Background This study was conducted to investigate the risk factors of anastomotic fistula after the radical resection of esophageal‐cardiac cancer. Methods Five hundred and forty‐four esophageal‐cardiac cancer patients who underwent surgery and had complete clinical data were included in the study. Fifty patients diagnosed with postoperative anastomotic fistula were considered the case group and the remaining 494 subjects who did not develop postoperative anastomotic fistula were considered the control. The potential risk factors for anastomotic fistula, such as age, gender, diabetes history, smoking history, were collected and compared between the groups. Statistically significant variables were substituted into logistic regression to further evaluate the independent risk factors for postoperative anastomotic fistulas in esophageal‐cardiac cancer. Results The incidence of anastomotic fistulas was 9.2% (50/544). Logistic regression analysis revealed that female gender (P < 0.05), laparoscopic surgery (P < 0.05), decreased postoperative albumin (P < 0.05), and postoperative renal dysfunction (P < 0.05) were independent risk factors for anastomotic fistulas in patients who received surgery for esophageal‐cardiac cancer. Of the 50 anastomotic fistulas, 16 cases were small fistulas, which were only discovered by conventional imaging examination and not presenting clinical symptoms. All of the anastomotic fistulas occurred within seven days after surgery. Five of the patients with anastomotic fistulas underwent a second surgery and three died. Conclusion Female patients with esophageal‐cardiac cancer treated with endoscopic surgery and suffering from postoperative hypoproteinemia and renal dysfunction were susceptible to postoperative anastomotic fistula.
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Affiliation(s)
- Jinxi Huang
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Zhou
- Department of Anesthesiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenghu Wang
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiwei Yuan
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhandong Zhang
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Beibei Chen
- Depatment of Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiefu Zhang
- Department of General Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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11
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Zhang Y, Zhang YX, Hu JW, Yao GY, Xue L, Fan H, Zhang YQ, Wang Q. Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy. J Thorac Dis 2017; 9:3052-3061. [PMID: 29221279 DOI: 10.21037/jtd.2017.08.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Intrathoracic anastomotic leakage (IAL) remains a major complication of esophagectomy. Main non-surgical options of management include chest drainage and endoscope interventions. This study is aim to present our experience and assess the efficacy of endoscopic naso-leakage drainage (ENLD) in patients with IAL. Methods From June 2011 to January 2017, 67 patients who developed IAL after esophagectomy and managed by non-surgical approaches were analyzed retrospectively. IAL was confirmed by clinical presentations combined with the evidence of CT scan, radiography and endoscopy. Thirty-eight patients were treated by conventional chest drainage (CD group) and 29 patients underwent ENLD with or without chest drainage (ENLD group), while other treatments including enteral nutrition and antibiotics had no difference between the two groups. In ENLD group, a 12 Fr naso-leakage tube was placed through the leakage to the bottom of vomica under ultra-slim electronic gastroscope. The naso-leakage tube was then connected to a gastrointestinal decompression device for drainage and was also used for rinse. When the vomica diminished and the drainage was also clean, the naso-leakage tube could be pulled back gradually. Finally, healing of the leakage was confirmed endoscopically. Clinical records of the two groups were analyzed. Results In ENLD group, naso-leakage tubes were successfully placed under endoscope in all 29 patients without any procedure-related complications. In CD group, the mortality is 7.9% (three patients) and five patients (13.2%) developed to systemic inflammatory response syndrome (SIRS) due to insufficient drainage. While in ENLD group, there was only one patient (3.4%) developed to SIRS and no death was observed, but the difference was not statistically significant. When compared with the CD group, the ENLD group had a shorter healing course (44.2±18.3 vs. 60.5±27.7 days, P=0.008), duration of antibiotics usage (16.4±7.8 vs. 11.8±3.8 days, P<0.001) and duration of fever (4.3±2.2 vs. 9.5±8.6 days, P=0.002). Conclusions To our initial experience, ENLD is an ideal option with safety and efficacy in management of IAL after esophagectomy.
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Affiliation(s)
- Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong-Xing Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guang-Yu Yao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Liang Xue
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Fan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Kanamori J, Okada N, Fujiwara H, Mayanagi S, Fujita T, Nagino M, Daiko H. Leak grading and percutaneous transanastomotic drainage for the treatment of cervical anastomotic leakage after esophagectomy. Dis Esophagus 2017; 30:1-7. [DOI: 10.1093/dote/dow029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Shuto K, Kono T, Akutsu Y, Uesato M, Mori M, Matsuo K, Kosugi C, Hirano A, Tanaka K, Okazumi S, Koda K, Matsubara H. Naso-esophageal extraluminal drainage for postoperative anastomotic leak after thoracic esophagectomy for patients with esophageal cancer. Dis Esophagus 2017; 30:1-9. [PMID: 27862613 DOI: 10.1111/dote.12492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Postoperative anastomotic leaks and subsequent mediastinal abscess are serious complications. The purpose of this study was to assess the efficacy of naso-esophageal extraluminal drainage after thoracic esophagectomy with gastric conduit reconstruction using a posterior mediastinal route. About 50 of 365 patients (13.7%) with esophageal cancer and postoperative anastomotic leak after curative esophagectomy was investigated. Beginning in June 2009, naso-esophageal extraluminal drainage by inserting a naso-esophageal aspiration tube into the abscess cavity when percutaneous abscess drainage was introduced which was ineffective or technically impossible. Twenty-five patients underwent naso-esophageal extraluminal drainage concomitantly with enteral nutrition. Twenty-one (84%) patients had major leaks, one (4%) minor leak and three (12%) had endoscopically proven conduit necrosis. None of the naso-esophageal extraluminal drainage cases (100%) required reintervention or reoperation and all experienced complete cure (100%) during hospitalization. Endoscopic balloon dilatation was performed for four patients after discharge because of anastomotic stricture. Patients with leaks were divided into two groups: current group (n = 32), treated after June 2009, and preceding group (n = 18), treated prior to the introduction of naso-esophageal extraluminal drainage. Significantly more patients in the preceding group suffered respiratory failure (28% vs. 61%, p = 0.024), and higher reoperation rate (0% vs. 17%, p = 0.042) and hospital mortality (0% vs. 22%, p = 0.013). In the current group, 31 (97%) patients experienced complete cure during hospitalization. Naso-esophageal extraluminal drainage and concomitant enteral nutritional support are less invasive, and effective and powerful methods to treat even major leakage after esophagectomy. These methods may be an alternative management to improve mortality for patients with esophageal cancer.
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Affiliation(s)
- Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan.,Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tsuguaki Kono
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Akutsu
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaya Uesato
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Kenichi Matsuo
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Atsushi Hirano
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Kuniya Tanaka
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Shinich Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Xu K, Chen S, Bian W, Xie H, Ma H, Ni B. Digital subtraction angiography-guided esophagography, intraluminal drainage, and endoscopic clipping-complex managements for intrathoracic esophagogastric anastomotic leak. J Surg Res 2016; 204:68-74. [PMID: 27451870 DOI: 10.1016/j.jss.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/23/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intrathoracic esophagogastric anastomotic leak is a critical complication after esophagectomy. Recently, novel complex diagnostic and therapeutic managements for intrathoracic esophagogastric anastomotic leak have been performed at our institution. MATERIALS AND METHODS Sixty-seven consecutive patients with intrathoracic esophagogastric anastomotic leak after esophagectomy from January 2009 to May 2015 at our institution were reviewed. Thirty-nine patients received conventional managements (conventional group), in which they were diagnosed via contrast swallow when there was a suspicion of anastomotic leak and were subsequently treated with a metallic stent. Twenty-eight patients received complex managements (complex group), in which they were diagnosed using digital subtraction angiography, an intraluminal drainage tube was placed, and clips were subsequently performed under an endoscope. The outcomes of the two groups were retrospectively analyzed. RESULTS There were no significant differences (P > 0.05) between the two groups in the preoperative general clinical data, whereas the postoperative data exhibited some differences. Compared with the conventional group, the confirmation time and recovery time are significantly decreased in the complex group (P < 0.01 and P < 0.01, respectively), and the incidence of severe complications is also lower (P < 0.01); however, there were no significant differences in the mortality rate between the two groups (P > 0.05). CONCLUSIONS Complex managements may represent a useful therapeutic option for postoperative esophagogastric anastomotic leak.
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Affiliation(s)
- Kai Xu
- The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Shaomu Chen
- The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Wen Bian
- The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Hongya Xie
- The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Haitao Ma
- The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Bin Ni
- The Department of Cardiothoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
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van Halsema EE, van Hooft JE. Clinical outcomes of self-expandable stent placement for benign esophageal diseases: A pooled analysis of the literature. World J Gastrointest Endosc 2015. [PMID: 25685270 DOI: 10.4253/wjge.v7.i2.135.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM To analyze the outcomes of self-expandable stent placement for benign esophageal strictures and benign esophageal leaks in the literature. METHODS The PubMed, Embase and Cochrane databases were searched for relevant articles published between January 2000 and July 2014. Eight prospective studies were identified that analyzed the outcomes of stent placement for refractory benign esophageal strictures. The outcomes of stent placement for benign esophageal leaks, perforations and fistulae were extracted from 20 retrospective studies that were published after the inclusion period of a recent systematic review. Data were pooled and analyzed using descriptive statistics. RESULTS Fully covered self-expandable metal stents (FC SEMS) (n = 85), biodegradable (BD) stents (n = 77) and self-expandable plastic stents (SEPS) (n = 70) were inserted in 232 patients with refractory benign esophageal strictures. The overall clinical success rate was 24.2% and according to stent type 14.1% for FC SEMS, 32.9% for BD stents and 27.1% for SEPS. Stent migration occurred in 24.6% of cases. The overall complication rate was 31.0%, including major (17.7%) and minor (13.4%) complications. A total of 643 patients were treated with self-expandable stents mainly for postsurgical leaks (64.5%), iatrogenic perforations (19.6%), Boerhaave's syndrome (7.8%) and fistulae (3.7%). FC SEMS and partially covered SEMS were used in the majority of patients. Successful closure of the defect was achieved in 76.8% of patients and according to etiology in 81.4% for postsurgical leaks, 86.0% for perforations and 64.7% for fistulae. The pooled stent migration rate was 16.5%. Stent-related complications occurred in 13.4% of patients, including major (7.8%) and minor (5.5%) complications. CONCLUSION The outcomes of stent placement for refractory benign esophageal strictures were poor. However, randomized trials are needed to put this into perspective. The evidence on successful stent placement for benign esophageal leaks, perforations and fistulae is promising.
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Affiliation(s)
- Emo E van Halsema
- Emo E van Halsema, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Emo E van Halsema, Jeanin E van Hooft, Department of Gastroenterology and Hepatology, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
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Guo J, Chu X, Liu Y, Zhou N, Ma Y, Liang C. Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy. World J Surg Oncol 2014; 12:402. [PMID: 25547979 PMCID: PMC4320535 DOI: 10.1186/1477-7819-12-402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 12/03/2014] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy. Methods Clinical data from 33 patients who developed intrathoracic anastomotic leak were evaluated retrospectively. These patients were selected from 1867 patients undergoing resection carcinoma of the esophagus and reconstruction between January 2003 and December 2012. Results Surgical intervention and the reformed “three-tube method” were applied in 13 and 20 patients, respectively. The overall incidence of intrathoracic anastomotic leakage was 1.8%. The median time interval from esophagectomy to diagnosis of leak was 9.7 days. Sixteen patients were confirmed as having leakage by oral contrast computed tomography (CT). Age and interval from surgery to diagnosis of leak were identified as statistically significant parameters between contained and uncontained groups. Moreover, patients with hypoalbuminemia had a longer time to leak closure than patients without hypoalbuminemia. Six patients died from intrathoracic anastomotic leak, with a mortality rate of 18.2%. There was no statistically significant difference in the time to leak closure between patients who underwent surgical exploration and those who received conservative treatment. Conclusions Intrathoracic anastomotic leak after esophagectomy was associated with significant mortality. Once intrathoracic anastomotic leakage following esophagectomy was diagnosed or highly suspected, individualized management strategies should be implemented according to the size of the leak, extent of the abscess, and status of the patient. In the majority of patients with anastomotic leak, we preferred the strategy of conservative treatment.
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Affiliation(s)
| | | | | | | | | | - Chaoyang Liang
- Department of Thoracic Surgery, PLA General Hospital, 28# Fuxing Street, Beijing, China.
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Ye HY, Huang WZ, Wu YM, Liang Y, Zheng JM, Jiang HM. Personalized management of anastomotic leak after surgery for esophageal carcinoma. ACTA ACUST UNITED AC 2012; 27:35-40. [PMID: 22734212 DOI: 10.1016/s1001-9294(12)60020-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To summarize the management of anastomotic leak following surgery for esophageal carcinoma. METHODS The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. RESULTS A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0 +/- 31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. CONCLUSIONS Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method. The efficacy of stent implantation needs further investigation to confirm.
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Xu QY, Yin GW, Chen SX, Jiang F, Bai XJ, Wu JD. Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage. Br J Radiol 2012; 85:1477-81. [PMID: 22806622 DOI: 10.1259/bjr/53905073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). METHODS From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients' nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. RESULTS The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49 ± 0.42 g dl(-1)) to the post-enteral feeding (3.58 ± 0.47 g dl(-1)) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). CONCLUSION The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.
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Affiliation(s)
- Q Y Xu
- Department of Interventional Radiology, Cancer Hospital of Jiangsu Province, Cancer Institution of Jiangsu Province, Nanjing, China
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Yin G, Xu Q, Chen S, Bai X, Jiang F, Zhang Q, Xu L, Xu W. Fluoroscopically guided three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage. Korean J Radiol 2012; 13:182-8. [PMID: 22438685 PMCID: PMC3303901 DOI: 10.3348/kjr.2012.13.2.182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 09/22/2011] [Indexed: 01/13/2023] Open
Abstract
Objective To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). Materials and Methods From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. Results The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 ± 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 ± 0.40 g/dL) to post-enteral feeding (3.7 ± 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). Conclusion Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
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Affiliation(s)
- Guowen Yin
- Department of Interventional Radiology, Cancer Institution of Jiangsu Province, Nanjing, China
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