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

Gastrointest Endosc. 2010 Feb;71(2):382-6. doi: 10.1016/j.gie.2009.07.011. Epub 2009 Oct 30.


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 193 +/- 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 days. A median of 7 endoscopic interventions was necessary. No major treatment-associated short-term or long-term (follow-up, 193 +/- 137 days) 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. (This study is registered at, identifier NCT00876551.).

Publication types

  • Clinical Trial

MeSH terms

  • Academic Medical Centers
  • Aged
  • Anastomosis, Surgical / adverse effects*
  • Anastomosis, Surgical / methods
  • Endoscopy / methods
  • Esophagectomy / adverse effects
  • Esophagectomy / methods
  • Female
  • Fistula / etiology
  • Fistula / surgery*
  • Follow-Up Studies
  • Gastrectomy / adverse effects
  • Gastrectomy / methods
  • Humans
  • Male
  • Middle Aged
  • Negative-Pressure Wound Therapy*
  • Postoperative Complications / surgery
  • Prospective Studies
  • Risk Assessment
  • Sampling Studies
  • Thoracic Diseases / etiology
  • Thoracic Diseases / surgery*
  • Treatment Outcome

Associated data