Abstract
Simple SummaryFlexible endoscopy has an important part in the diagnosis and treatment of postoperative complications after oncologically intended esophagectomy. Endoscopy offers the possibility of effective therapy with minimal invasiveness at the same time, and the use of endoscopic therapy procedures can avoid re-operations. In this review we present the advantages of endoscopic treatment opportunities during the last 20 years regarding patients’ treatment after esophageal cancer resection. According to prevalence and clinical relevance, four relevant postoperative complications were identified and their endoscopic treatment procedures discussed. All endoscopic therapy procedures for anastomotic bleeding, anastomotic insufficiencies, anastomotic stenosis and postoperative delayed gastric emptying are presented, including innovative developments. Background: Esophageal cancer (EC) is the sixth-leading cause of cancer-related deaths in the world. Esophagectomy is the most effective treatment for patients without invasion of adjacent organs or distant metastasis. Complications and relevant problems may occur in the early post-operative course or in a delayed fashion. Here, innovative endoscopic techniques for the treatment of postsurgical problems were developed during the past 20 years. Methods: Endoscopic treatment strategies for the following postoperative complications are presented: anastomotic bleeding, anastomotic insufficiency, delayed gastric passage and anastomotic stenosis. Based on a literature review covering the last two decades, therapeutic procedures are presented and analyzed. Results: Addressing the four complications mentioned, clipping, stenting, injection therapy, dilatation, and negative pressure therapy are successfully utilized as endoscopic treatment techniques today. Conclusion: Endoscopic treatment plays a major role in both early-postoperative and long-term aftercare. During the past 20 years, essential therapeutic measures have been established. A continuous development of these techniques in the field of endoscopy can be expected.
Highlights
Esophageal cancer ranks seventh in terms of incidence and sixth in overall mortality of cancer-related deaths in the world, with relevant differences in regional frequency [1]
Endoscopic treatment of hemorrhage in the gastrointestinal (GI) tract is based on three different procedures: elevated pressure to the submucosal layer due to mechanical measures, thermic hemostasis and application of absorbent substances
The choice of hemostasis technique depends on the preferences of the endoscopist and the age of the anastomosis
Summary
Esophageal cancer ranks seventh in terms of incidence and sixth in overall mortality of cancer-related deaths in the world, with relevant differences in regional frequency [1]. Surgical resection remains the “gold standard” of curative treatment for esophageal cancer [2]. According to the size and location of the tumor, the following different surgical methods and treatment strategies can be utilized. Complications and relevant problems may occur in the early postoperative course or in a delayed fashion. Innovative endoscopic techniques for the treatment of postsurgical problems were developed during the past 20 years. Methods: Endoscopic treatment strategies for the following postoperative complications are presented: anastomotic bleeding, anastomotic insufficiency, delayed gastric passage and anastomotic stenosis. Results: Addressing the four complications mentioned, clipping, stenting, injection therapy, dilatation, and negative pressure therapy are successfully utilized as endoscopic treatment techniques today. A continuous development of these techniques in the field of endoscopy can be expected
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