Update Course Rewind: Management of Esophageal Leaks 2022
With Dr. Miguel Guelfand · hosted by Dr. Cecilia Gigena
Chapter 1 of 5 · Case-Based Learning
Contained leaks
Introduction and First Case: Contained Leak Management
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The endo-bag technique was described by Cristobal Abelo in a paper available online
With endoscopic vacuum therapy, the leak can be completely shut down immediately as seen on esophagram
The endo-bag device is kept in place for 4 or 5 days and then reviewed in the OR
In the case of surgical re-anastomosis for a large unexplained leak, the patient required no dilatation and had no stenosis at 3-week follow-up
Every small or moderate leak that is contained can be managed by observation with no need for new intervention
New intervention for esophageal leaks is only considered when leaks create huge pneumothorax that are not well drained, or if the patient is unstable
Botulinum toxin can be used to block the secretion of saliva in management of esophageal leaks
Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva
Retrograde endoscopy via gastrostomy tube can be used to dilate esophageal strictures when antegrade visualization is inadequate
Endoscopic vacuum closure (endo-bag) consists of an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive, connected to suction
Endoscopic vacuum closure helps granulation tissue form by negative pressure and makes the patient heal faster
Most esophageal leaks can be treated by observation or chest drain
If there is an external leak like in the neck or a fistula that is not healing well, an endovac can be a great solution
For some patients with deteriorated status or great leaks, a re-anastomosis can be attempted
After a leak, a stricture is more common, so the patient must be followed more thoroughly