Universität zu Köln

Scognamiglio, Pasquale, Reeh, Matthias, Melling, Nathaniel, Kantowski, Marcus, Eichelmann, Ann-Kathrin, Chon, Seung-Hun ORCID: 0000-0002-8923-6428, El-Sourani, Nader ORCID: 0000-0002-6146-7785, Schoen, Gerhard, Hoeller, Alexandra, Izbicki, Jakob R. and Tachezy, Michael (2022). Management of intra-thoracic anastomotic leakages after esophagectomy: updated systematic review and meta-analysis of endoscopic vacuum therapy versus stenting. BMC Surg., 22 (1). LONDON: BMC. ISSN 1471-2482

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Abstract

Despite a significant decrease of surgery-related mortality and morbidity, anastomotic leakage still occurs in a significant number of patients after esophagectomy. The two main endoscopic treatments in case of anastomotic leakage are self-expanding metal stents (SEMS) and the endoscopic vacuum therapy (EVT). It is still under debate, if one method is superior to the other. Therefore, we performed a systematic review and meta-analysis of the existing literature to compare the effectiveness and the related morbidity of SEMS and EVT in the treatment of esophageal leakage. We systematically searched for studies comparing SEMS and EVT to treat anastomotic leak after esophageal surgery. Predefined endpoints including outcome, treatment success, endoscopy, treatment duration, re-operation rate, intensive care and hospitalization time, stricture rate, morbidity and mortality were assessed and included in the meta-analysis. Seven retrospective studies including 338 patients matched the inclusion criteria. Compared to stenting, EVT was significantly associated with higher healing (OR 2.47, 95% CI [1.30 to 4.73]), higher number of endoscopic changes (pooled median difference of 3.57 (95% CI [2.24 to 4.90]), shorter duration of treatment (pooled median difference - 11.57 days; 95% CI [- 17.45 to - 5.69]), and stricture rate (OR 0.22, 95% CI [0.08 to 0.62]). Hospitalization and intensive care unit duration, in-hospital mortality rate, rate of major and treatment related complications, of surgical revisions and of esophago-tracheal fistula failed to show significant differences between the two groups. Our analysis indicates a high potential for EVT, but because of the retrospective design of the included studies with potential biases, these results must be interpreted with caution. More robust prospective randomized trials should further investigate the potential of the two procedures.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Scognamiglio, Pasquale UNSPECIFIED UNSPECIFIED UNSPECIFIED Reeh, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Melling, Nathaniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Kantowski, Marcus UNSPECIFIED UNSPECIFIED UNSPECIFIED Eichelmann, Ann-Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Chon, Seung-Hun UNSPECIFIED orcid.org/0000-0002-8923-6428 UNSPECIFIED El-Sourani, Nader UNSPECIFIED orcid.org/0000-0002-6146-7785 UNSPECIFIED Schoen, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoeller, Alexandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Izbicki, Jakob R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tachezy, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-680697
DOI:	10.1186/s12893-022-01764-z
Journal or Publication Title:	BMC Surg.
Volume:	22
Number:	1
Date:	2022
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1471-2482
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NEGATIVE-PRESSURE THERAPY; OPEN-PORE FILM; ASSISTED CLOSURE; RESECTION; SURGERY; CANCER; LEAKS; DIAGNOSIS; OUTCOMES; IMPACT Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68069