Pattynama Lisanne M D, Pouw Roos E, Meijer Berrie, van Berge Henegouwen Mark I, Gisbertz Suzanne S, Yeung Kak Khee, Bergman Jacques J, Eshuis Wietse J
Department of Gastroenterology and Hepatology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Surg Endosc. 2025 Sep 10. doi: 10.1007/s00464-025-12029-0.
Endoscopic vacuum therapy (EVT) has been established as a safe and effective treatment for anastomotic leakage. While rare, major aortic hemorrhage has been reported as a severe complication potentially associated with EVT. However, significant hemorrhages have also been observed in patients with transmural defects in the upper gastrointestinal tract, without the use of EVT. This raises questions about the role of EVT as a direct cause of aortic hemorrhage.
The objective of this study was to further investigate the incidence of major aortic hemorrhage in patients with anastomotic leakage following esophagectomy, both before and after the introduction of EVT. This case series included all patients who experienced an aortic hemorrhage after an anastomotic leak over an 11-year period (January 2013-December 2023). Patients were identified from a prospectively maintained database at Amsterdam UMC and were categorized into two groups: the pre-EVT period and the EVT period.
In the pre-EVT period, 355 patients underwent a transthoracic esophagectomy, with 62 (17%) developing anastomotic leakage. In the EVT period, 527 patients underwent the same procedure, with 83 (16%) anastomotic leakages. A total of 7 patients developed a major aortic hemorrhage: 5 in the pre-EVT period (12%) and 2 in the EVT period (2%).
Although EVT has been proposed in literature as a potential cause of major aortic hemorrhage, our findings provide a more nuanced perspective. In this cohort, aortic hemorrhages tend to occur in case of severe mediastinitis, also without treatment with EVT.
内镜下真空治疗（EVT）已被确立为治疗吻合口漏的一种安全有效的方法。虽然罕见，但有报道称主动脉大出血是与EVT潜在相关的严重并发症。然而，在上消化道存在透壁缺损的患者中，即使未使用EVT，也观察到了严重出血。这引发了关于EVT作为主动脉出血直接原因的作用的疑问。
本研究的目的是进一步调查食管切除术后吻合口漏患者中主动脉大出血的发生率，包括在引入EVT之前和之后。该病例系列包括在11年期间（2013年1月至2023年12月）所有在吻合口漏后发生主动脉出血的患者。患者从阿姆斯特丹大学医学中心前瞻性维护的数据库中识别出来，并分为两组：EVT前时期和EVT时期。
在EVT前时期，355例患者接受了经胸食管切除术，其中62例（17%）发生了吻合口漏。在EVT时期，527例患者接受了相同的手术，其中83例（16%）发生了吻合口漏。共有7例患者发生了主动脉大出血：EVT前时期5例（12%），EVT时期2例（2%）。
尽管文献中曾提出EVT可能是主动脉大出血的原因，但我们的研究结果提供了一个更细致入微的观点。在这个队列中，主动脉出血往往发生在严重纵隔炎的情况下，即使没有接受EVT治疗。
