Endoscopic management of esophageal anastomotic leaks after surgery for malignant disease Journal Article

Authors: Licht, E.; Markowitz, A. J.; Bains, M. S.; Gerdes, H.; Ludwig, E.; Mendelsohn, R. B.; Rizk, N. P.; Shah, P.; Strong, V. E.; Schattner, M. A.
Article Title: Endoscopic management of esophageal anastomotic leaks after surgery for malignant disease
Abstract: Background Esophageal anastomotic leaks after cancer surgery remain a major cause of morbidity and mortality. Endoscopic interventions, including covered metal stents (cSEMS), clips, and direct percutaneous endoscopic jejunostomy (dPEJ) tubes are increasingly used despite limited published data regarding their utility in this setting. This study aimed to determine the efficacy and safety of a multimodality endoscopic approach to anastomotic leak management after operation for esophageal or gastric cancer. Methods We performed a retrospective review of prospectively maintained databases of gastric and esophageal operations at our hospital between January 2003 and December 2012. Included patients had an operation for esophageal or gastric cancer, demonstrated evidence of an anastomotic leak at the esophageal anastomosis, and underwent attempted endoscopic therapy. Healing was defined as clinical and radiographic leak resolution. Results Forty-nine patients with leaks underwent endoscopic management. Of the 49 patients, 31 (63%) received cSEMS, 40 (82%) had dPEJ tubes inserted, and 3 (6%) received clips. Twenty-three (47%) patients underwent a combined approach. Overall, 88% of patients achieved healing in a median of 83 days. Twenty-two of 23 patients (96%) who underwent a multimodality endoscopic approach healed. Only 1 patient had a major complication associated with stent erosion into the pulmonary artery, which was successfully treated with operative repair. Conclusions Esophageal anastomotic leaks after esophageal and gastric cancer operations can be managed successfully and safely with endoscopic therapy. Combining cSEMS for leak control and dPEJ tube placement for nutritional support was highly effective in achieving healing, without the need for surgical repair. © 2016 The Society of Thoracic Surgeons.
Keywords: adult; clinical article; aged; cancer surgery; data base; retrospective study; postoperative complication; hospital; esophagus resection; stent; endoscopic therapy; esophageal adenocarcinoma; stomach adenocarcinoma; esophageal squamous cell carcinoma; esophagus anastomosis; anastomosis leakage; total stomach resection; erosion; stent migration; clip; human; male; female; priority journal; article; esophageal anastomotic leak; jejunum interposition; stent erosion
Journal Title: Annals of Thoracic Surgery
Volume: 101
Issue: 1
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2016-01-01
Start Page: 301
End Page: 304
Language: English
DOI: 10.1016/j.athoracsur.2015.06.072
PROVIDER: scopus
PUBMED: 26428689
PMCID: PMC4910386
Notes: Article -- Export Date: 3 March 2016 -- Source: Scopus
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MSK Authors
  1. Hans Gerdes
    125 Gerdes
  2. Arnold J Markowitz
    109 Markowitz
  3. Nabil Rizk
    134 Rizk
  4. Emmy Ludwig
    45 Ludwig
  5. Vivian Strong
    144 Strong
  6. Mark Schattner
    102 Schattner
  7. Manjit S Bains
    227 Bains
  8. Pari Mayank Shah
    22 Shah
  9. Eugene   Licht
    3 Licht
  10. Pavak Kirit Shah
    6 Shah