Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses

Background: The mortality of thoracic anastomotic leakage following esophag eal reconstruction has been reported to be as high as 60%. Early septic ful minant suture line leaks require rethoracotomy. In addition, however, clini cally symptomatic leaks may also occur 2 to 7 days after resection of the e sophagus. Methods: Among 80 esophageal reconstructions performed between January 1994 and July 1998, a total of 7 (8.75%) clinically apparent leaks of thoracic anastomoses were observed. The standard treatment consisted of endoscopic l avage, drainage and subsequent closure of the defect by repeated intralumin al and submucosal applications of fibrin glue. In 2 patients a novel approa ch permitting rapid closure by plugging the fistula with a Vicryl-cylinder was tried. in 4 patients the effect of endoscopic treatment on the HLA-DR e xpression on monocytes was investigated and compared to 6 patients with int act anastomoses. Results: All 7 patients were successfully treated via endoscopy. The cylind er plug achieved immediate closure of the leak. The measured change in HLA- DR expression reflected the improvement in the inflammatory response and th us documented the success of endoscopic treatment. Conclusions: Endoscopic management of thoracic leakages represents a safe a nd relatively noninvasive therapeutic option.