Published online Jul 16, 2013. doi: 10.4253/wjge.v5.i7.340
Revised: May 14, 2013
Accepted: June 1, 2013
Published online: July 16, 2013
Processing time: 117 Days and 7.2 Hours
AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage.
METHODS: Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker’s diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week.
RESULTS: The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy.
CONCLUSION: E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.
Core tip: Traditional methods to treat cervical esophageal leakage close to the upper esophageal sphincter are associated with high morbidity and mortality. The newly developed method of endoscopic-vacuum assisted closure (E-VAC) therapy using polyurethane sponges has been demonstrated as efficacious for treating gastrointestinal tract leakages. We applied E-VAC therapy to three patients with post-operative cervical leakage and achieved complete closure in all, without any procedure-related complications. The E-VAC therapy was well tolerated by patients with cervical esophageal leakage, and its application in this patient population may contribute to a significant reduction in morbidity and mortality.