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
Expert statements on this page
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Host summaries · secondary, not cited in answers
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
In the cervical leak case, the leak was completely shut down immediately after endo-bag placement and completely closed at 5 days.
The endo-bag device is kept in place for 4 or 5 days and then reviewed in the OR.
After surgical re-anastomosis for the large leak, the patient had no stenosis at 3 days and 3 weeks post-operatively and required no dilatation.
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 patients with esophageal leaks.
Glycopyrrolate is a medicine available in the US that blocks the secretion of saliva.
Retrograde endoscopy via gastrostomy tube is used when normal endoscopy cannot visualize the esophagus adequately due to stricture.
Endoscopic vacuum closure (endo-bag) is constructed from an NG tube with a hose covered by a surgical sponge, which is covered by a perforated transparent adhesive.
Endoscopic vacuum closure helps granulation tissue form by negative pressure, making 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 patients have to be followed more thoroughly.