Endoscopic-Vacuum-Therapy in Esophgageous Perforations and Anastomotic Leakages after Esophagectomy. The Best Treatment Option to Solve a Major Complication in Upper GI-Surgery?

Anastomotic leakages and esophageous perforations remain to be severe complications of the upper gastrointestinal (GI) tract. Reported leak rates after esophagectomy vary widely from 1% to 30% [1]. According to the severity of the anastomotic leakage, the time interval after primary surgery, the general condition of the patient and/or the anastomotic location several treatment options are available, such as conservative, endoscopic or surgical treatment [2-4]. Nevertheless, the mortality of anastomotic leakage can exceed 50% [5]. Also, in patients with esophageal perforations high mortality rates close to 20% [6-8], despite recent progress in surgical, endoscopic, intensive care, and infectious treatment options have been reported. The mortality rate of patients requiring surgical revision due to an anastomotic leakage after esophageal resection are very divergent in the literature and reach from 3.3% up to 67% [3,9-11]. Therefore, leakage from an esophageal anastomosis is a life-threatening complication and optimal management is of tremendous importance. The surgical treatment options reach from the redo of the anastomosis with augmentation of the anastomotic area by vital tissue (e.g. muscle flap, omental flap) to complete surgical deviation by taking down the esophageal conduit and creation of a cervical stoma [3,9-11].