Back to Search
Start Over
Management of esophageal anastomotic leaks, a systematic review and network meta-analysis.
- Source :
-
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus [Dis Esophagus] 2024 Jul 03; Vol. 37 (7). - Publication Year :
- 2024
-
Abstract
- There is currently no consensus as to how to manage esophageal anastomotic leaks. Intervention with endoscopic vacuum-assisted closure (EVAC), stenting, reoperation, and conservative management have all been mooted as potential options. To conduct a systematic review and network meta-analysis (NMA) to evaluate the optimal management strategy for esophageal anastomotic leaks. A systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines with extension for NMA. NMA was performed using R packages and Shiny. In total, 12 retrospective studies were included, which included 511 patients. Of the 449 patients for whom data regarding sex was available, 371 (82.6%) were male, 78 (17.4%) were female. The average age of patients was 62.6 years (standard deviation 10.2). The stenting cohort included 245 (47.9%) patients. The EVAC cohort included 123 (24.1%) patients. The conservative cohort included 87 (17.0%) patients. The reoperation cohort included 56 (10.9%) patients. EVAC had a significantly decreased complication rate compared to stenting (odds ratio 0.23 95%, confidence interval [CI] 0.09;0.58). EVAC had a significantly lower mortality rate than stenting (odds ratio 0.43, 95% CI 0.21; 0.87). Reoperation was used in significantly larger leaks than stenting (mean difference 14.66, 95% CI 4.61;24.70). The growing use of EVAC as a first-line intervention in esophageal anastomotic leaks should continue given its proven effectiveness and significant reduction in both complication and mortality rates. Surgical management is often necessary for significantly larger leaks and will likely remain an effective option in uncontained leaks with systemic features.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Humans
Female
Male
Middle Aged
Negative-Pressure Wound Therapy methods
Aged
Esophagus surgery
Anastomosis, Surgical adverse effects
Anastomosis, Surgical methods
Esophagectomy adverse effects
Esophagectomy methods
Conservative Treatment methods
Retrospective Studies
Treatment Outcome
Anastomotic Leak surgery
Anastomotic Leak etiology
Anastomotic Leak therapy
Stents
Reoperation statistics & numerical data
Reoperation methods
Network Meta-Analysis
Subjects
Details
- Language :
- English
- ISSN :
- 1442-2050
- Volume :
- 37
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
- Publication Type :
- Academic Journal
- Accession number :
- 38525940
- Full Text :
- https://doi.org/10.1093/dote/doae019