Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system

Background: Endoscopic treatment options for postsurgical intrathoracic leaks include injection of fibrin glue, clip application, and stent placement. Endoscopic vacuum-assisted Closure (E-VAC) may be an effective treatment option. Objective: To demonstrate that E-VAC is an effective endoscopic treatment option for Closure of major intrathoracic postsurgical leaks. Design and Setting: A prospective, single-center Study at an academic medical center. Patients: Eight consecutive patients with major intrathoracic postsurgical leaks. Interventions: Endoscopic placement of transnasal draining tubes, armed With a size-adjusted sponge at their distal end, in the necrotic anastomotic cavities, followed by continuous suction. Sponge and drainage were changed twice weekly. Patients were followed-up for 1.93 +/- 137 days. Main Outcome Measurement: Successful leak closure. Results: Successful Closure of leaks was achieved in 7 of 8 patients (88%) after a mean of 23 +/- 8 clays. A median of 7 endoscopic interventions was necessary. No major treatment-associated short-term or long-term (follow-up, 193 +/- 137 clays) complications were noted. Limitations: Small sample size, single-center study, and lack of randomization. Conclusion: E-VAC is an effective endoscopic treatment modality for major postsurgical intrathoracic leaks.