Background and Aims
Therapeutic endoscopy plays a critical role in the management of upper GI (UGI) postsurgical
leaks. Data are scarce regarding clinical success and safety. Our aim was to evaluate
the effectiveness of endoscopic therapy for UGI postsurgical leaks and associated
adverse events (AEs) and to identify factors associated with successful endoscopic
therapy and AE occurrence.
Methods
This was a retrospective, multicenter, international study of all patients who underwent
endoscopic therapy for UGI postsurgical leaks between 2014 and 2019.
Results
Two hundred six patients were included. Index surgery most often performed was sleeve
gastrectomy (39.3%), followed by gastrectomy (23.8%) and esophagectomy (22.8%). The
median time between index surgery and commencement of endoscopic therapy was 16 days.
Endoscopic closure was achieved in 80.1% of patients after a median follow-up of 52
days (interquartile range, 33-81.3). Seven hundred seventy-five therapeutic endoscopies
were performed. Multimodal therapy was needed in 40.8% of patients. The cumulative
success of leak resolution reached a plateau between the third and fourth techniques
(approximately 70%-80%); this was achieved after 125 days of endoscopic therapy. Smaller
leak initial diameters, hospitalization in a general ward, hemodynamic stability,
absence of respiratory failure, previous gastrectomy, fewer numbers of therapeutic
endoscopies performed, shorter length of stay, and shorter times to leak closure were
associated with better outcomes. Overall, 102 endoscopic therapy–related AEs occurred
in 81 patients (39.3%), with most managed conservatively or endoscopically. Leak-related
mortality rate was 12.4%.
Conclusions
Multimodal therapeutic endoscopy, despite being time-consuming and requiring multiple
procedures, allows leak closure in a significant proportion of patients with a low
rate of severe AEs.
Graphical abstract
Graphical Abstract
Abbreviations:
AE (adverse event), EID (endoscopic internal drainage), EVT (endoscopic vacuum therapy), FC-SEMS (fully covered self-expandable metal stent), IQR (interquartile range), OR (odds ratio), OTSC (over-the-scope clip), RYGB (Roux-en-Y gastric bypass), SEMS (self-expandable metal stent), UGI (upper GI)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 16, 2020
Accepted:
October 9,
2020
Received:
July 22,
2020
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: S. Irani: Research support from Boston Scientific. R Kozarek: Institutional research grant from Boston Scientific. A. Repici: Consultant for Boston Scientific, Erbe, Fujifilm, Medtronic, EndoKey, EndoStart, and Q3Medical. P. Rogalski, A. Baniukiewicz: Consultant for Boston Scientific. V. Kumbhari: Consultant for Medtronic, Pentax Medical, Boston Scientific, FujiFilm, and Apollo Endosurgery; research support from Erbe USA. M. A. Khashab: Consultant for Boston Scientific, Olympus, Medtronic, GI Supply, and Triton. A. R. Schulman: Consultant for Boston Scientific, Apollo Endosurgery, and MicroTech; research support from GI Dynamics. All other authors disclosed no financial relationships.
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- Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dikeGastrointestinal EndoscopyVol. 93Issue 6
- PreviewPostsurgical leaks and fistulas are devastating adverse events (AEs) leading to prolonged hospitalization, considerable morbidity, and significant mortality.1 An anastomotic leak is the strongest independent risk factor for postoperative mortality, with rates up to 15%. Spontaneous closure rates of leaks with conservative and radiologic interventions are highly variable, ranging from 16% to 46%.1 In patients who undergo rescue or redo surgery, the mortality increases to 15% to 30% and recurrence in up to one third of patients.
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