Endoscopic drainage of esophageal suture line leaks

Suture line leaks after esophageal or gastric surgery are associated with high morbidity and mortality rates. We report a new approach to the management of this problem, which has been used successfully in the treatment of nine patients with such leaks who were treated at or referred to our unit. The suture line defect is first visualized by endoscopy, after which a sump nasogastric tube is advanced down the esophagus and out through the defect into the abscess cavity. The tubes are irrigated intermittently to achieve patency and maintained with continuous suction. Separate pleural or subphrenic collections are drained by conventional techniques. After the injection of contrast down the tube, serial radiologic studies are used to monitor progress and to guide the slow withdrawal of the tube as the cavity collapses.