Esophagoenteric anastomotic leaks: treatment with fluoroscopically guided balloon dilatation

Disruption of anastomosis soon after esophagectomy and esophagoenterostomy is a relatively common complication that leads to chronic enterocutaneous fistulous drainage through the surgical wound in the lower part of the neck or upper part of the chest. It is believed that narrowing of the anastomosis by postsurgical edema and granulation tissue forces the flow of swallowed saliva through the disrupted anastomosis and contributes to the maintenance of the leakage. We evaluated the role of fluoroscopically guided balloon dilatation for treatment of these esophagoenteric anastomotic leaks.

Sixteen consecutive patients with leaking esophagoenteric anastomoses in the neck or the upper part of the chest underwent fluoroscopically guided dilatations of the anastomosis 7-32 days (mean, 13 days) after surgery with 15- or 20-mm angioplasty balloons. Dilatation was done empirically, regardless of whether the anastomosis was visibly narrowed. Discharge of secretions through the surgical drains in the wounds was measured before and after the procedure to determine the response to treatment.

In 10 patients whose anastomoses were leaking for an average of 6 days before the balloon dilatation, drainage ceased immediately after the procedure. In four patients with leakage averaging 13 days, response to dilatation was delayed; drainage continued briefly after the procedure but ceased after an average of 5 days. In one patient, drainage increased after dilatation but ceased after 4 days. In another patient, drainage continued for more than 2 weeks after the procedure, after which a second dilatation was performed without apparent success as drainage persisted for another 10 days. In no case was there evidence of further disruption of the anastomosis by the balloon dilatation.

Fluoroscopically guided balloon dilatation appears to be an effective and safe technique for treatment of leaking esophagoenteric anastomoses. Early intervention seems to increase the effectiveness of the procedure.