International Society for Diseases of the Esophagus consensus on the diagnosis and treatment of anastomotic leak after esophagectomy

Background: Anastomotic leak (AL) is a severe complication after esophagectomy. Guidelines for the management of AL are lacking. This study aimed to develop a consensus statement for managing AL after esophagectomy. A three-stage modified Delphi study was performed in collaboration with the International Society for Diseases of the Esophagus Guidelines Committee. In Stage 1, a scoping systematic review was performed to identify available literature used to formulate Delphi statements. Stage 2 involved a two-round Delphi survey, distributed globally to surgeons and gastroenterologists. Consensus was defined as ≥80% (strong) (dis)agreement on a Delphi statement. During Stage 3 (guideline development), an international expert panel formulated clinical recommendations based on Delphi consensus and assigned strength in line with Grading of Recommendations Assessment, Development, and Evaluation principles. A clinical care algorithm was developed based on these recommendations. Of 5.843 articles screened, 118 were included to form Delphi statements. The Delphi survey was completed by 106 respondents in the first round and 136 in the second. Based on Delphi consensus and expert panel discussions, 12 diagnostic recommendations were formulated, covering clinical signs, biochemical tests, and imaging strategies. 11 recommendations were formulated regarding treatment strategies, including indications and techniques for supportive care, drainage and defect closure. This led to the development of a clinical care algorithm. A consensus statement for the diagnosis and treatment of AL after esophagectomy was developed. This may aid clinicians in the diagnosis and management of AL and provide a tool for standardizing clinical practice with the aim to improve patient outcomes.