Department of Evidence-Based Medicine, Centro Universitário Lusíada, São Paulo, Brazil.
Department of Evidence-Based Medicine, Universidade de São Paulo, São Paulo, Brazil.
Dis Esophagus. 2021 May 22;34(5). doi: 10.1093/dote/doaa132.
The curative treatment for esophageal and gastric cancer is primarily surgical resection. One of the main complications related to esophagogastric surgery is the anastomotic leak. This complication is associated with a prolonged length of stay, reduced quality of life, high treatment costs, and an increased mortality rate. The placement of endoluminal stents is the most frequent endoscopic therapy in these cases. However, since its introduction, endoscopic vacuum therapy has been shown to be a promising alternative in the management of this complication. This study primarily aims to evaluate the efficacy and safety of endoscopic vacuum therapy for the treatment of anastomotic leak in esophagectomy and total gastrectomy. A systematic review and meta-analysis was performed. Studies that evaluated the use of endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy were included. Twenty-three articles were included. A total of 559 patients were evaluated. Endoscopic vacuum therapy showed a fistulous orifice closure rate of 81.6% (rate: 0.816; 95% CI: 0.777-0.864) and, when compared to the stent, there is a 16% difference in favor of endoscopic vacuum therapy (risk difference [RD]: 0.16; 95% CI: 0.05-0.27). The risk for mortality in the endoscopic vacuum therapy was 10% lower than in endoluminal stent therapy (RD: -0.10; 95% CI: -0.18 to -0.02). Endoscopic vacuum therapy might have a higher rate of fistulous orifice closure and a lower rate of mortality, compared to intraluminal stenting.
食管和胃癌的主要治疗方法是手术切除。食管胃手术后的主要并发症之一是吻合口漏。这种并发症与住院时间延长、生活质量降低、治疗费用增加和死亡率增加有关。在这些情况下，放置腔内支架是最常见的内镜治疗方法。然而，自引入以来，内镜真空治疗已被证明是治疗这种并发症的一种很有前途的替代方法。本研究主要旨在评估内镜真空治疗在食管切除术和全胃切除术后吻合口漏治疗中的疗效和安全性。进行了系统评价和荟萃分析。纳入评估内镜真空治疗在食管切除术和全胃切除术后吻合口漏的研究。共纳入 23 篇文章。共评估了 559 例患者。内镜真空治疗的瘘口闭合率为 81.6%（率：0.816；95%CI：0.777-0.864），与支架相比，内镜真空治疗的差异有 16%有利于前者（风险差异[RD]：0.16；95%CI：0.05-0.27）。内镜真空治疗的死亡率比腔内支架治疗低 10%（RD：-0.10；95%CI：-0.18 至-0.02）。与腔内支架治疗相比，内镜真空治疗可能具有更高的瘘口闭合率和更低的死亡率。
