Cwaliński J, Hermann J, Kasprzyk M, Banasiewicz T. Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report. World J Gastrointest Endosc 2020; 12(1): 42-48 [PMID: 31942233 DOI: 10.4253/wjge.v12.i1.42]
Corresponding Author of This Article
Jarosław Cwaliński, MD, PhD, Academic Research, Doctor, Lecturer, Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan 60-355, Poland. cwalinski.jaroslaw@spsk2.pl
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 16, 2020; 12(1): 42-48 Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.42
Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence: A case report
Jarosław Cwaliński, Jacek Hermann, Mariusz Kasprzyk, Tomasz Banasiewicz
Jarosław Cwaliński, Jacek Hermann, Tomasz Banasiewicz, Department of General and Endocrynologic Surgery and Gastroenterologic Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
Mariusz Kasprzyk, Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan 60-355, Poland
Author contributions: All authors contributed equally to this work; Cwaliński J wrote the initial manuscript and reviewed the images; Hermann J prepared English language editing; Cwaliński J, Hermann J and Kasprzyk M performed procedures; Banasiewicz T drafted the concepts and designed the study.
Informed consent statement: The therapy described was in accordance with the principles of medical ethics and good medical practice. Patients provided informed written consent prior to all medical procedures and for the publication of this report.
Conflict-of-interest statement: Authors declare no conflict of interest regarding this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jarosław Cwaliński, MD, PhD, Academic Research, Doctor, Lecturer, Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan 60-355, Poland. cwalinski.jaroslaw@spsk2.pl
Received: May 8, 2019 Peer-review started: May 10, 2019 First decision: May 31, 2019 Revised: September 19, 2019 Accepted: November 6, 2019 Article in press: November 6, 2019 Published online: January 16, 2020 Processing time: 223 Days and 11.1 Hours
Abstract
BACKGROUND
Esophagogastric leakage is one of the most severe postoperative complications. Partial disruption of the anastomosis, can be successfully treated with an endoscopic vacuum assisted closure (E-VAC). The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess. The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.
CASE SUMMARY
Two male patients developed a potentially life threatening esophagogastric leakage. Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction. Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears. Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances, and treatment of sepsis with appropriate antibiotics.
CONCLUSION
Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy. Through individual approach it allows a more accurate assessment of healing.
Core tip: Postoperative esophagogastric leakage might be successfully treated with conservative measures either with well-established endoscopic stenting or endoscopic vacuum assisted closure with respect to the type and localization of leakage. The advantage of vacuum treatment is a continuous evacuation of septic discharge and an individual adjustment of the dressing depending on the size of the dehiscence. The application of an endoscopic vacuum dressing is relatively simple, cost-effective, easily accessible and in many cases, it avoids consecutive laparotomies.
