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Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks

Published:October 16, 2020DOI:https://doi.org/10.1016/j.gie.2020.10.015

      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

      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)
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      Linked Article

      • Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike
        Gastrointestinal EndoscopyVol. 93Issue 6
        • Preview
          Postsurgical 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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