Anastomotic leakage following resection of the esophagus—introduction of an endoscopic grading system

Jeannine Bachmann, Marcus Feith, Christoph Schlag, Mohamed Abdelhafez, Marc E. Martignoni, Helmut Friess

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage. Methods: Patients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. Endoscopy In this retrospective analysis, the focus is to describe different patterns of leakage of the anastomosis. Results: We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With the increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of the development of a fistula to the tracheobronchial system increased with higher grades of leakage. Conclusions: Exact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with a special focus on prospective analysis.

Original languageEnglish
Article number104
JournalWorld Journal of Surgical Oncology
Issue number1
StatePublished - Dec 2022
Externally publishedYes


  • Anastomotic leakage
  • Endoluminal vacuum therapy
  • Endoscopic grading system


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