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Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis

Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the “gold standard” for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of...

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Autores principales: Mandarino, Francesco Vito, Barchi, Alberto, D’Amico, Ferdinando, Fanti, Lorella, Azzolini, Francesco, Viale, Edi, Esposito, Dario, Rosati, Riccardo, Fiorino, Gionata, Bemelman, Willem Adrianus, Elmore, Ugo, Barbieri, Lavinia, Puccetti, Francesco, Testoni, Sabrina Gloria Giulia, Danese, Silvio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968149/
https://www.ncbi.nlm.nih.gov/pubmed/36836644
http://dx.doi.org/10.3390/life13020287
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author Mandarino, Francesco Vito
Barchi, Alberto
D’Amico, Ferdinando
Fanti, Lorella
Azzolini, Francesco
Viale, Edi
Esposito, Dario
Rosati, Riccardo
Fiorino, Gionata
Bemelman, Willem Adrianus
Elmore, Ugo
Barbieri, Lavinia
Puccetti, Francesco
Testoni, Sabrina Gloria Giulia
Danese, Silvio
author_facet Mandarino, Francesco Vito
Barchi, Alberto
D’Amico, Ferdinando
Fanti, Lorella
Azzolini, Francesco
Viale, Edi
Esposito, Dario
Rosati, Riccardo
Fiorino, Gionata
Bemelman, Willem Adrianus
Elmore, Ugo
Barbieri, Lavinia
Puccetti, Francesco
Testoni, Sabrina Gloria Giulia
Danese, Silvio
author_sort Mandarino, Francesco Vito
collection PubMed
description Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the “gold standard” for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. Methods: A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. Results: Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43–4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08–6.71), shorter treatment duration (pmd −9.18, 95% CI −17.05–−1.32), lower short-term complication (OR 0.35, 95% CI 0.18–0.71) and mortality rates (OR 0.47, 95% CI 0.24–0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74–3.40, I(2) = 0%). Conclusions: Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks.
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spelling pubmed-99681492023-02-27 Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis Mandarino, Francesco Vito Barchi, Alberto D’Amico, Ferdinando Fanti, Lorella Azzolini, Francesco Viale, Edi Esposito, Dario Rosati, Riccardo Fiorino, Gionata Bemelman, Willem Adrianus Elmore, Ugo Barbieri, Lavinia Puccetti, Francesco Testoni, Sabrina Gloria Giulia Danese, Silvio Life (Basel) Systematic Review Background: Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the “gold standard” for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. Methods: A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. Results: Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43–4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08–6.71), shorter treatment duration (pmd −9.18, 95% CI −17.05–−1.32), lower short-term complication (OR 0.35, 95% CI 0.18–0.71) and mortality rates (OR 0.47, 95% CI 0.24–0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74–3.40, I(2) = 0%). Conclusions: Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks. MDPI 2023-01-19 /pmc/articles/PMC9968149/ /pubmed/36836644 http://dx.doi.org/10.3390/life13020287 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Mandarino, Francesco Vito
Barchi, Alberto
D’Amico, Ferdinando
Fanti, Lorella
Azzolini, Francesco
Viale, Edi
Esposito, Dario
Rosati, Riccardo
Fiorino, Gionata
Bemelman, Willem Adrianus
Elmore, Ugo
Barbieri, Lavinia
Puccetti, Francesco
Testoni, Sabrina Gloria Giulia
Danese, Silvio
Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis
title Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis
title_full Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis
title_fullStr Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis
title_full_unstemmed Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis
title_short Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis
title_sort endoscopic vacuum therapy (evt) versus self-expandable metal stent (sems) for anastomotic leaks after upper gastrointestinal surgery: systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968149/
https://www.ncbi.nlm.nih.gov/pubmed/36836644
http://dx.doi.org/10.3390/life13020287
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