Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy

Our research focuses on endoscopic vacuum therapy for anastomotic leakage following total gastrectomy with esophagojejunostomy. We aim to evaluate its effectiveness, clarify the treatment protocol, assess its safety, and measure its clinic outcomes. Endoscopic vacuum therapy is a breakthrough in the management of anastomotic leaks, digestive tract fistulas, and perforations.

Recent advancements include the expansion of clinical indications and the refinement of treatment protocols for more precise treatment. Meanwhile, our team is investigating its application in colorectal anastomotic leakage to further optimize its clinical use. Endoscopic vector therapy is a highly effective minimally invasive treatment for gastrointestinal anastomotic leakage.

When performing traditional measures, it accelerates reduces complication risks and lowers the need for reoperation. The implementation of standardized protocols further enhances its safety and efficacy. To begin, select an FDA approved open cell polyurethane ether foam.

Shape it to fit the leakage or abscess cavity and prepare a 6.0 French or 18 gastric drainage tube. Then, securely wrap the foam around the tip of the drainage tube. Fix it in place using 3-0 polypropylene sutures, ensuring that all drainage side holes are completely covered.

After anesthetizing the patient and lubricating the endoscope, insert it into the esophagus through the mouth and advance it toward the abscess cavity. Irrigate the anastomotic leak or abscess cavity with normal saline until it is fully cleared and the effluent is clear. Now, place a nasojejunal feeding tube under endoscopic guidance.

Using endoscopic forceps, grasp the suture line, securing the tip of the tube and sponge. Then, push the sponge into the leakage cavity. Under endoscopic guidance, confirm that the sponge has entered or is attached to the abscess cavity.

Then, drain the EVTDD tube and the nasojejunal feeding tube through the same nasal cavity. Endoscopy during the first endoscopic procedure revealed a one by 1.5 centimeter leakage at the esophagojejunal anastomosis surrounded by a yellow white purulent coating with visible suture lines and vascular clips. The endoscopic vacuum therapy double drain device was successfully positioned to ensure effective drainage during the first procedure.

Endoscopy during the second procedure showed that the leakage size had reduced with minor mucosal bleeding observed around the edges. By the third procedure, the leakage had shrunk significantly, making its size difficult to measure. One month after discharge, upper gastrointestinal radiography confirmed no contrast leakage, indicating full closure of the defect.