Scognamiglio, Pasquale, Reeh, Matthias, Karstens, Karl, Bellon, Eugen, Kantowski, Marcus, Schoen, Gerhard, Zapf, Antonia, Chon, Seung-Hun ORCID: 0000-0002-8923-6428, Izbicki, Jakob R. and Tachezy, Michael (2020). Endoscopic vacuum therapy versus stenting for postoperative esophago-enteric anastomotic leakage: systematic review and meta-analysis. Endoscopy, 52 (8). S. 632 - 643. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1438-8812

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Abstract

Background Esophageal anastomotic leakage still represents a challenging complication after esophageal surgery. Endoscopically placed self-expandable metal stents (SEMS) are the treatment of choice, but since the introduction of endoscopic vacuum therapy (EVT) for esophageal leakage 10 years ago, increasing evidence has demonstrated that EVT might be a superior alternative. Therefore, we performed a systematic review and meta-analysis to compare the effectiveness and related morbidity of SEMS and EVT in the treatment of esophageal leak. Methods We systematically searched for studies comparing SEMS and EVT to treat anastomotic leakage after esophageal surgery. Predefined end points including outcome, treatment success, endoscopy, treatment duration, hospitalization time, morbidity, and mortality were assessed and included in the meta-analysis. Results Five retrospective studies including 274 patients matched the inclusion criteria. Compared with stenting, EVT was significantly associated with a higher rate of leak closure (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.23 to 7.98), more endoscopic device changes (pooled median difference of 3.09; 95 % CI 1.54 to 4.64]), a shorter duration of treatment (pooled median difference - 11.90 days; 95% CI - 18.59 to -5.21 days), and a lower mortality rate (OR 0.39, 95 % CI 0.18 to 0.83). There were no significant differences in short-term and major complications. Conclusions Owing to the retrospective quality of the studies with potential biases, the results of the meta-analysis must be interpreted with caution. However, the analysis indicates the potential benefit of EVT, which should be further investigated with standardized and prospectively collected data.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Scognamiglio, PasqualeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reeh, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karstens, KarlUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bellon, EugenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kantowski, MarcusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schoen, GerhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zapf, AntoniaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chon, Seung-HunUNSPECIFIEDorcid.org/0000-0002-8923-6428UNSPECIFIED
Izbicki, Jakob R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tachezy, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-325083
DOI: 10.1055/a-1149-1741
Journal or Publication Title: Endoscopy
Volume: 52
Number: 8
Page Range: S. 632 - 643
Date: 2020
Publisher: GEORG THIEME VERLAG KG
Place of Publication: STUTTGART
ISSN: 1438-8812
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ASSISTED CLOSURE; SURGICAL-MANAGEMENT; COMPLICATIONS; SURGERY; RESECTION; IMPACT; CANCER; DIAGNOSIS; CONSENSUS; SURVIVALMultiple languages
Gastroenterology & Hepatology; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/32508

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