Closing the gap: endoscopic treatment of esophageal anastomotic leakage-a retrospective cohort study

A variety of endoscopic techniques are available for the closure of esophageal defects, each offering distinct advantages. Endoscopic vacuum therapy (EVT) has emerged as a highly effective approach. Alternatively, fully covered self-expanding metal stents (SEMS) can be placed intraluminally until defect closure is achieved. For smaller defects, over-the-scope clips (OTSC®) provide a viable option. However, comparative data remain limited and reported closure rates vary widely across the literature. This study aimed to evaluate and compare closure rates of postoperative anastomotic leaks treated with EVT, SEMS, and OTSC® at two specialized centers in Germany.

This retrospective study included all patients treated endoscopically for anastomotic leakage at two tertiary gastroenterological centers between May 2007 and February 2023. The primary endpoint was successful endoscopic defect closure. Secondary endpoints included in-hospital mortality, need for revision surgery, duration of therapy, hospital stay length, time to treatment initiation, and procedure-related complications.

A total of 59 patients (71% male, mean age 64 years) were included. In 94.9% of cases, surgery was performed for oncologic indications; 46% had received neoadjuvant therapy. The most common procedure was Ivor Lewis esophagectomy (89.8%). EVT was used in 24 patients, SEMS in 32, and OTSC® in 14. The overall closure rate was 78.0%. Patients with successful closure had a significantly lower ASA score (p = 0.039), smaller defects (≤ 1 cm: 57.8% vs. 15.4%, p = 0.007), lower in-hospital mortality (2.2% vs. 38.5%, p < 0.001), and reduced need for revision surgery (0% vs. 61.5%, p < 0.001).

The success of endoscopic therapy is closely linked to patient health status and defect size. Notably, esophageal defects ≤ 1 cm can almost always be closed successfully using endoscopic methods.