Endoscopic vacuum therapy for intrathoracic anastomotic insufficiencies following oncological resections

Dörte Wichmann, Ulrike Schempf, Benedikt Mothes, Dietmar Stüker, Alfred Königsrainer, Ulrich Schweizer, Christoph Reinhold Werner


Endoscopic vacuum therapy (EVT) is a promising method to treat patients with leakages of the intestinal tract. We present a concise overview of recent publications about EVT for endoscopic complication management in intrathoracic anastomotic leaks (IAL) following oncological resections. Patients with esophageal carcinomas or carcinomas of the esophageal gastric junction are critical patients because of low nutritional status, passed chemotherapy and visceral surgery with one or two cave resections. Literature database search was carried out until July 2019. Case series of more than 5 patients treated with EVT for intrathoracic leaks, cohort trials and controlled trials were included. Additional studies were found by hand searching reference lists. Search resulted in a current literature-overview composed of 13 original articles gathered data from 340 patients with different causes of intrathoracic leaks treated with EVT. Overall 213 patients with intrathoracic anastomotic insufficiencies were treated with EVT. Rate of success in these patients was nearly 90%. The available data indicate that EVT is feasible, safe and results in a high rate of defect closure, rapid recoveries with few short-term complications and low mortality and morbidity rates in patients with anastomotic insufficiencies. EVT seems to be an effective tool for the complication management in intrathoracic anastomotic insufficiencies. Application of EVT is easy to learn, especially for intraluminal placement of the open pore polyurethane sponge drainage (OPD). A prospective multi-center study has to be conducted to proof the definite benefit of EVT for postsurgical management of insufficiencies.