Endoscopy 2019; 51(04): S194
DOI: 10.1055/s-0039-1681744
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Leaks 2 ePoster Podium 5
Georg Thieme Verlag KG Stuttgart · New York

EFFICACY OF ENDOSCOPIC VACUUM ASSISTED CLOSURE TREATMENT FOR POSTOPERATIVE ANASTOMOTIC LEAK OF GASTRIC CANCER

JC Park
1   Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of
,
SI Choi
1   Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of
,
EH Kim
1   Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of
,
SK Shin
1   Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of
,
SK Lee
1   Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of
,
YC Lee
1   Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Aims:

Endoscopic vacuum assisted closure (EVAC) has been attempted as new non-surgical treatment option for anastomotic leakage. We evaluate the clinical outcomes of EVAC and compare efficacy with self-expandable metallic stents (SEMS) in post-gastrectomy leakage.

Methods:

Between Jan 2010 and Feb 2018, total 39 cases of anastomotic leak after gastrectomy for treatment of gastric cancer were reviewed. Twenty-eight patients were treated with SEMS only, 7 patients were treated with EVAC after SEMS failure, and 4 patients were treated with EVAC only. We compared clinical characteristics and therapeutic outcomes between EVAC (N = 11) and SEMS (N = 28).

Results:

Median follow up duration of EVAC and SEMS were 17 months (range, 0 – 48). All cases treated with EVAC were healing successfully (100%) and did not occurred mortality. Two cases of treatment failure (7.1%) including 1and case of mortality (3.6%) were occurred in patients who treated with SEMS. Median duration of EVAC treatment (15 days [6 – 47]) was shorter than SEMS (36 days [7 – 108]; p < 0.001). Relatively larger size leakage was treated successfully with EVAC (median 2.1 cm [1.5 – 3.3] in EVAC and 1.0 cm [0.2 – 2.5] in SEMS; p < 0.001). Median weight loss at first outpatient department visit after treatment was 8 kg (-3 to 15) in EVAC and 9 kg (2 to 20) in SEMS. The duration of antibiotics use was similar between two groups as median 27.5 days (10 – 94) and 23.5 days (0 – 79). After EVAC therapy, 1 case of anastomotic stenosis was occurred at 147 days after EVAC removal. (9.1%). In SEMS therapy, 4 cases (14.3%) of anastomotic stenosis occurred at median 102 days (29 – 319).

Conclusions:

EVAC can be effective endoscopic treatment option for post-gastrectomy anastomotic leak. Considering of the leak size may be important when determining treatment options. Further large number randomized controlled trials are needed to define efficacy of EVAC.