Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMC Surg. 2022 Aug 11;22(1):309. doi: 10.1186/s12893-022-01764-z.
Despite a significant decrease of surgery-related mortality and morbidity, anastomotic leakage still occurs in a significant number of patients after esophagectomy. The two main endoscopic treatments in case of anastomotic leakage are self-expanding metal stents (SEMS) and the endoscopic vacuum therapy (EVT). It is still under debate, if one method is superior to the other. Therefore, we performed a systematic review and meta-analysis of the existing literature to compare the effectiveness and the related morbidity of SEMS and EVT in the treatment of esophageal leakage. We systematically searched for studies comparing SEMS and EVT to treat anastomotic leak after esophageal surgery. Predefined endpoints including outcome, treatment success, endoscopy, treatment duration, re-operation rate, intensive care and hospitalization time, stricture rate, morbidity and mortality were assessed and included in the meta-analysis. Seven retrospective studies including 338 patients matched the inclusion criteria. Compared to stenting, EVT was significantly associated with higher healing (OR 2.47, 95% CI [1.30 to 4.73]), higher number of endoscopic changes (pooled median difference of 3.57 (95% CI [2.24 to 4.90]), shorter duration of treatment (pooled median difference - 11.57 days; 95% CI [- 17.45 to - 5.69]), and stricture rate (OR 0.22, 95% CI [0.08 to 0.62]). Hospitalization and intensive care unit duration, in-hospital mortality rate, rate of major and treatment related complications, of surgical revisions and of esophago-tracheal fistula failed to show significant differences between the two groups. Our analysis indicates a high potential for EVT, but because of the retrospective design of the included studies with potential biases, these results must be interpreted with caution. More robust prospective randomized trials should further investigate the potential of the two procedures.
尽管手术相关的死亡率和发病率显著下降，但食管切除术后仍有大量患者发生吻合口漏。吻合口漏的两种主要内镜治疗方法是自膨式金属支架（SEMS）和内镜真空治疗（EVT）。一种方法是否优于另一种方法仍存在争议。因此，我们对现有文献进行了系统回顾和荟萃分析，以比较 SEMS 和 EVT 在治疗食管漏中的有效性和相关发病率。我们系统地搜索了比较 SEMS 和 EVT 治疗食管手术后吻合口漏的研究。包括结局、治疗成功率、内镜、治疗持续时间、再次手术率、重症监护和住院时间、狭窄率、发病率和死亡率在内的预定终点，并纳入荟萃分析。符合纳入标准的有 7 项回顾性研究，共纳入 338 例患者。与支架置入相比，EVT 与更高的愈合率（OR 2.47，95%CI [1.30 至 4.73]）、更多的内镜改变（合并中位数差值为 3.57（95%CI [2.24 至 4.90]）、更短的治疗持续时间（合并中位数差值-11.57 天；95%CI [-17.45 至 -5.69]）和狭窄率（OR 0.22，95%CI [0.08 至 0.62]）相关。两组间住院和重症监护病房持续时间、住院死亡率、主要并发症和治疗相关并发症发生率、手术修订率以及食管气管瘘发生率无显著差异。我们的分析表明 EVT 具有很高的潜力，但由于纳入研究的回顾性设计存在潜在偏倚，这些结果必须谨慎解释。更多稳健的前瞻性随机试验应进一步研究这两种方法的潜力。
