1798 An Endoscopic Vacuum-Assisted Closure Technique Modified Through the Overtubes for Patients With Esophageal Anastomotic Leaks

Abstract

INTRODUCTION: Endoscopic vacuum-assisted closure (E-VAC) therapy is safe and effective for esophageal anastomotic leaks. However, the repetitive exchange of sponge tubes is technically demanding. CASE DESCRIPTION/METHODS: We designed an E-VAC technique, modified through the use of overtube, to make E-VAC therapy safer and more comfortable for both endoscopists and patients. Intraluminal E-VAC therapies were used for the treatment of post-operative thoracic esophageal leaks in five cases of esophageal cancer. After overtube insertion, sponge tube was inserted through the overtube, while keeping biopsy forcep inside the nasogastric tube (NGT), and was positioned at intraluminal leakage site under endoscopic guidance. NGT was repositioned from the mouth to the nostrils using carrier tube and a controlled negative pressure was applied. Sponge tube was regularly changed twice a week until the complete closure of leaks. Technical and clinical success rates were analyzed to evaluate the safety and efficacy of this technique. The modified E-VAC therapy was applied in five selected cases for a mean of 13.8 days (range, 7-28 days) with a mean of 3.2 sponge tube changes (2-6 changes) for anastomotic leaks that were, on average, 1.0 cm (0.5-2 cm). The mean procedural time was 14.9 min (12-30 min) and no E-VAC therapy-related complications occurred. All patients were discharged, on average, after 44.4 days (range, 14-95 days) of hospitalization and two cases were treated with additional esophageal metal stents after six and two sponge tube changes, respectively. DISCUSSION: Our E-VAC therapy technique, modified via inserting sponge tubes through overtube, is effective and safe for patients with thoracic esophageal anastomotic leaks.