Letter to the Editor

Successful Endoscopic Clip Closure of Postoperative Esophageal Leak

Authors: Ankur Sheth, MD, MPH, FACP, Deepthi Bollineni, MD, Kenneth Manas, MD

Abstract

To the Editor:


Esophageal leaks can occur secondary to instrumental or pathologic perforation, postsurgical anastomotic leak, or formation of benign or malignant esophageal fistulae. Repair of the leak and diversion of the luminal contents along with nutritional support and antibiotics is the cornerstone of managing esophageal leaks. An anastomotic leak is noted in 4–17% of patients following esophageal resection; however, a standardized therapy has not yet been established. While acute esophageal perforations/leaks with significant contamination of visceral spaces should undergo surgery, a conservative approach is indicated in selected patients with asymptomatic and minimal leaks.1 Recently, endoscopic options have emerged in the management of esophageal leaks. This includes the use of endoclips, stents, glue, endoscopic sutures, and staples.2 We report a case of the successful closure of an anastomotic esophageal leak utilizing endoclips.

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References

1. Pross M, Manger T, Reinheckel T, et al. Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc 2000;51:73–76.
 
2. Raju GS. Endoscopic closure of gastrointestinal leaks. Am J Gastroenterol 2009;104:1315–1320.
 
3. Rodella L, Laterza E, De Manzoni G, et al. Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy 1998;30:453–456.
 
4. Qadeer MA, Dumot JA, Vargo JJ, et al. Endoscopic clips for closing esophageal perforations: case report and pooled analysis. Gastrointest Endosc 2007;66:605–611.
 
5. Wehrmann T, Stergiou N, Vogel B, et al. Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series. Gastrointest Endosc 2005;62:344–349.