394. ENDOSCOPIC VACUUM THERAPY FOR PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGO-GASTRIC SURGERY

Abstract

Abstract Anastomotic leakage (AL) is one of the most serious complications of upper gastro-intestinal (UGI) surgery. Recently endoscopic vacuum therapy (EVT), using an endoscopically placed sponge, was introduced as treatment of AL. The aim of this study was to describe the initial experiences with EVT in a tertiary referral center, in the treatment of AL after esophago-gastric surgery. For this retrospective cohort study, all patients treated with EVT for AL in the UGI tract at a tertiary referral center, between January 2018 and October 2021, were included. In this period, patients with AL, based on CT-scan or endoscopic findings, were primarily treated with EVT. Cases were identified from the endoscopy reporting system, with a search including all available terms for EVT, and from the prospective UGI surgery database. Data on patient characteristics, EVT and outcomes were analyzed. The primary endpoint was success rate of EVT alone, defined as closure of the defect assessed by endoscopy or CT-scan. A total of 38 patients were included (Table 1). Successful treatment with EVT was achieved in 28 patients (74%, 95%CI[57,87]). In 10 patients EVT failed: one deceased during treatment (due to radiation pneumonitis) and 9 underwent additional surgery: two due to an EVT-related complication (a trachea-esophageal fistula and iatrogenic expansion of the defect during overtube placement) and 7 because defect closure was not achieved. EVT-associated complications occurred in two patients, as described above. Median hospital stay was 42 days. Median duration of EVT was 27 days, with median 6 EVT-related endoscopies and 5 days between sponge-exchanges. EVT is a paradigm shifting treatment, potentially preventing surgical re-intervention in patients with AL after UGI surgery, with a success rate of 74%. More experience with the technique and indications for use will likely improve success rates in the future.