Endoscopic Management of Anastomotic Esophageal Leaks

Esophageal anastomotic leak is one of the most feared complications of esophagectomy and is associated with a prolonged hospitalization and a high mortality. Until recently, the management options included either surgical re-exploration and repair or aggressive medical management (antibiotics, percutaneous drainage, nutritional support, and nil-by-mouth). Repair of esophageal leaks can now also be accomplished endoscopically without surgical thoracotomy using endoscopic clip closure of the leak, bypass of the leak with the insertion of a stent, and plugging of the hole with tissue sealants. These novel endoluminal therapeutic options are certainly worthy of further exploration to manage these patients better. We have attempted to summarize these recent developments in the endoluminal therapy of anastomotic leaks.

Keywords:  esophageal anastomotic leaks , endoscopy , endoclips , stents , glue , debridement , mediastinal drainage