Introduction: With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95% CI: 23.9–48.5%]. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI: 0.127–0.954]), shorter ICU length of stay (mean difference −14.77 days [95% CI: −26.57 to −2.98]), and time until AL resolution (17.6 days [95% CI: 14.1–21.2] vs. 39.4 days [95% CI: 27.0–51.8]) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay. Conclusions: Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).
GE Port J Gastroenterol

中文翻译：

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胃食管癌手术后吻合口漏：内镜与手术治疗的系统回顾和荟萃分析

简介：随着食管癌和胃癌的增加，手术将越来越频繁。吻合口漏（AL）是胃食管手术最令人担心的术后并发症之一。它可以通过保守、内窥镜（如内窥镜真空治疗和支架置入术）或手术方法进行治疗，但最佳治疗方法仍存在争议。我们荟萃分析的目的是比较 (a) 内窥镜和手术干预措施以及 (b) 胃食管癌手术后 AL 的不同内窥镜治疗方法。方法：系统回顾和荟萃分析，在三个在线数据库中搜索评估胃食管癌手术后 AL 的手术和内镜治疗的研究。结果：总共纳入了 32 项研究，涉及 1,080 名患者。与手术干预相比，内镜治疗的临床成功率、住院时间和重症监护病房住院时间相似，但院内死亡率较低（6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95] % CI：23.9–48.5%]。内镜真空治疗与较低的并发症发生率（OR 0.348 [95% CI：0.127–0.954]）、较短的 ICU 住院时间相关（平均差 -14.77 天 [95% CI：与支架置入术相比，AL 消退的时间为 -26.57 至 -2.98]），以及 AL 消退的时间（17.6 天 [95% CI：14.1–21.2] 与 39.4 天 [95% CI：27.0–51.8]），但没有显着差异就临床成功率、死亡率、再干预或住院时间而言。结论：与手术相比，内窥镜治疗，特别是内窥镜真空治疗似乎更安全、更有效。然而，需要更强有力的比较研究，特别是为了澄清在特定情况下哪种是最佳治疗方法（根据患者和泄漏特征）。
GE Port J 胃肠科