Faris Hammad, MD1, Yazan Fahmawi, MD2, Yousef Abdel-Aziz, MD, MPH3, Sami Ghazaleh, MD4, Haneen Abdalhadi, MD2, Lindsey Merritt, DO2, Meir Mizrahi, MD2, Tariq Hammad, MD5; 1Saint Vincent Hospital, Cleveland, OH; 2University of South Alabama, Mobile, AL; 3University of Tennessee Health Science Center, Memphis, TN; 4University of Toledo Medical Center, Toledo, OH; 5West Virginia University, School of Medicine, Bridgeport, WV
Introduction: Anastomotic leak is one of the serious complications after esophagectomy with an incidence rate of 3-25%. The optimal treatment for anastomotic leak remains unclear. Conservative management, surgical conversion, and/ or endoscopic management with clipping or stent placement, have been the traditional methods to manage anastomotic leak. However, they have been associated with high adverse events and failure rates. Endoscopic Vacuum Therapy (EVT) is an emerging technique for management of anastomotic leak. EVT is based on applying continuous negative pressure on the leak site by polyethylene sponges which facilitate drainage of the leaking fluid, proximate the edges and induce granulation tissue formation. In our study, we aim to assess the clinical success and adverse event rates of EVT in the management of Esophageal Leaks. Methods: We searched PubMed, Cochrane Library, and Scopus from inception to January 2020 for studies reporting the clinical success and adverse event rates of EVT for esophageal anastomotic leaks. We excluded studies with < 5 patients. Clinical success was defined as a complete healing of the perforation. Heterogeneity was assessed using I2. Depending on the heterogeneity, pooled estimates and the 95% confidence interval (CI) were calculated using either random-effect or fixed-effect models. Results: Fourteen studies (11 retrospective and 3 prospective) involving 229 patients with esophageal anastomotic leak and treated by EVT, were included in this study. The indication of esophagectomy was esophageal cancer in all patients. The pooled overall clinical success rate was 89.1% (95%CI: 85.1-93%, I2= 0%) (Figure 1). The pooled complication rate was 14.5% (95%CI: 5.8- 23.3%, I2= 69.1%). The most common complication was strictures in 14 cases followed by endosponge dislocation in 5 cases. Stent placement was required in 10.1% of the cases whereas surgical conversion was required in 2.2% of the cases. EVT-related mortality was reported in two cases. Discussion: EVT is a novel modality and it seems to be a safe and effective approach of therapy in patients with anastomotic leak after esophagectomy. However, large prospective studies comparing it with the traditional methods are warranted.
Figure 1: Forrest Plot for Clinical Success Rate
Disclosures: Faris Hammad indicated no relevant financial relationships. Yazan Fahmawi indicated no relevant financial relationships. Yousef Abdel-Aziz indicated no relevant financial relationships. Sami Ghazaleh indicated no relevant financial relationships. Haneen Abdalhadi indicated no relevant financial relationships. Lindsey Merritt indicated no relevant financial relationships. Meir Mizrahi indicated no relevant financial relationships. Tariq Hammad indicated no relevant financial relationships.