COMPARATIVE STUDY
JOURNAL ARTICLE

Management of gastrointestinal leaks after minimally invasive esophagectomy: conventional treatments vs. endoscopic stenting

Ninh T Nguyen, Patrick Donohue Rudersdorf, Brian R Smith, Kevin Reavis, Xuan-Mai T Nguyen, Michael J Stamos
Journal of Gastrointestinal Surgery 2011, 15 (11): 1952-60
21904963

INTRODUCTION: Gastrointestinal leak is a dreaded complication after esophagectomy. Conventional treatments for leak include conservative therapy, surgical reoperation, and even complete gastrointestinal (GI) diversion. The aim of this study was to evaluate the impact of endoluminal stenting in the management of esophagogastric leak after esophagectomy.

METHODS: Data on 18 (11.3%) of 160 patients who developed postoperative leaks after minimally invasive esophagectomy were reviewed. Indications for esophagectomy included carcinoma (n = 14), Barrett's with high-grade dysplasia (n = 3), and benign stricture (n = 1). Neoadjuvant therapy was used in 57.1% of patients with carcinoma. The first nine patients underwent conventional treatments for leak whereas the latter nine patients underwent endoscopic esophageal covered stenting as primary therapy. There were 5 cervical and 13 intrathoracic anastomotic leaks. Main outcome measures included patient characteristics, types of treatment, length of hospital stay, morbidity, and mortality.

RESULTS: Subjects were 16 males and 2 females with a mean age of 66 years. In the conventional treatment group, leaks were treated with neck drainage (n = 4), GI diversion (n = 2), and thoracoscopic drainage with or without repair or T-tube placement (n = 3). In the endoscopy group, all leaks were treated with endoscopic covered stenting with or without percutaneous drainage (n = 9). Control of leaks occurred in 89% of patients in the conventional treatment group vs. 100% of patients in the endoscopic stenting group. Three patients in the conventional treatment group (33%) required esophageal diversion compared to none of the patients in the endoscopy group. The 60-day or in-hospital mortality was 0% for both groups.

CONCLUSION: In our clinical practice, there has been a shift in the management of esophagogastric anastomotic leaks to nonsurgical therapy using endoscopic esophageal covered stenting. Endoluminal stenting is a safe and effective alternative in the management of GI leaks.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
21904963
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"