Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system

BackgroundEndoscopic treatment options for postsurgical intrathoracic leaks include injection of fibrin glue, clip application, and stent placement. Endoscopic vacuum-assisted closure (E-VAC) may be an effective treatment option.ObjectiveTo demonstrate that E-VAC is an effective endoscopic treatment option for closure of major intrathoracic postsurgical leaks.Design and SettingA prospective, single-center study at an academic medical center.PatientsEight consecutive patients with major intrathoracic postsurgical leaks.InterventionsEndoscopic placement of transnasal draining tubes, armed with a size-adjusted sponge at their distal end, in the necrotic anastomotic cavities, followed by continuous suction. Sponge and drainage were changed twice weekly. Patients were followed-up for 193 ± 137 days.Main Outcome MeasurementSuccessful leak closure.ResultsSuccessful closure of leaks was achieved in 7 of 8 patients (88%) after a mean of 23 ± 8 days. A median of 7 endoscopic interventions was necessary. No major treatment-associated short-term or long-term (follow-up, 193 ± 137 days) complications were noted.LimitationsSmall sample size, single-center study, and lack of randomization.ConclusionE-VAC is an effective endoscopic treatment modality for major postsurgical intrathoracic leaks. (This study is registered at Clinicaltrials.gov, identifier NCT00876551.)