Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks.

Published on Oct 17, 2020in Gastrointestinal Endoscopy6.89
· DOI :10.1016/J.GIE.2020.10.015
Eduardo Rodrigues-Pinto12
Estimated H-index: 12
Pedro Pereira28
Estimated H-index: 28
+ 20 AuthorsGuilherme Macedo23
Estimated H-index: 23
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.
#1Pasquale Scognamiglio (UHH: University of Hamburg)H-Index: 1
#2Matthias Reeh (UHH: University of Hamburg)H-Index: 16
Last. Michael Tachezy (UHH: University of Hamburg)H-Index: 22
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BACKGROUND: Esophageal anastomotic leakage still represents a challenging complication after esophageal surgery. Endoscopically placed self-expandable metal stents (SEMS) are the treatment of choice, but since the introduction of endoscopic vacuum therapy (EVT) for esophageal leakage 10 years ago, increasing evidence has demonstrated that EVT might be a superior alternative. Therefore, we performed a systematic review and meta-analysis to compare the effectiveness and related morbidity of SEMS a...
6 CitationsSource
#2Alessandro Repici (Humanitas University)H-Index: 71
Last. Mouen A. Khashab (Johns Hopkins University)H-Index: 69
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Background and study aims A variety of endoscopic techniques are currently available for treatment of upper gastrointestinal (UGI) anastomotic leaks; however, no definite consensus exists on the most appropriate therapeutic approach. Our aim was to explore current management of UGI anastomotic leaks. Methods A survey questionnaire was distributed among international expert therapeutic endoscopists regarding management of UGI anastomotic leaks. Results A total of 44 % of 163 surveys were returned...
7 CitationsSource
#2Rui MoraisH-Index: 23
Last. Guilherme MacedoH-Index: 23
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Background and Aims Therapeutic endoscopy plays a major role in the management of postbariatric anastomotic leaks, offering an effective treatment alternative to repeated surgery. In recent years, management has been moving from bridging and closing the leak’s orifice toward an approach that uses vacuum therapy or internal drainage. Our aim was to demonstrate different treatment options for the management of postbariatric leaks. Methods We describe 3 different endoscopic techniques for postbaria...
3 CitationsSource
#1Zachary L. Smith (Case Western Reserve University)H-Index: 14
#1Zachary L. Smith (Case Western Reserve University)H-Index: 11
Last. Vladimir Kushnir (WashU: Washington University in St. Louis)H-Index: 25
view all 26 authors...
Abstract Background Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. Leaks after sleeve gastrectomy (SGL) occur in 1% to 3% of patients. Endoscopic therapies are increasingly used for treatment of SGLs, but few data exist on their outcomes. Objectives The aim of this study was to assess technical success, leak resolution, and reoperation rates of patients undergoing endoscopic therapy for repair SGLs. Setting Eight high-volume academic endoscopy centers. ...
8 CitationsSource
Background Anastomotic leakage (0–30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature.
15 CitationsSource
#1Alberto BaptistaH-Index: 5
#2Diogo Turiani Hourneaux de Moura (USP: University of São Paulo)H-Index: 19
Last. Christopher C. Thompson (Brigham and Women's Hospital)H-Index: 59
view all 13 authors...
Background Endoscopy has evolved to become first-line therapy for the treatment of post-bariatric leaks; however, many sessions are often required with variable success rates. Due to these limitations, the use of the cardiac septal defect occluder (CSDO) has recently been reported in this population. Methods The study population was a multicenter retrospective series of patients with post-bariatric surgical leaks who underwent treatment with CSDO placement. Data on the type of surgery, previous ...
14 CitationsSource
#1Andrea AnderloniH-Index: 28
#2Chiara GencoH-Index: 9
Last. Alessandro RepiciH-Index: 71
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BACKGROUND/AIMS: The study aimed to evaluate the effectiveness and safety of self-expanding metal stents (SEMS) in the management of post-surgical esophageal leaks. METHODS: Retrospective data of consecutive patients with a post-surgical esophageal leak treated by means of a metal stent between January 2008 and December 2014 at the Humanitas Research Hospital (Milan, Italy) were extracted from a prospectively maintained register of SEMS used for benign indications, such as post-surgical benign e...
3 CitationsSource
#1Ossamu Okazaki (USP: University of São Paulo)H-Index: 2
#2Wanderley Marques Bernardo (USP: University of São Paulo)H-Index: 19
Last. Eduardo Guimarães Hourneaux de Moura (USP: University of São Paulo)H-Index: 25
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Fistula development is a serious complication after bariatric surgery. We performed a systematic review and meta-analysis to assess the efficacy of fistula closure and complications associated with endoscopic stent treatment of fistulas, developed after bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS). Studies involving patients with fistula after RYGB or GS and those who received stent treatment only were selected. The analyzed outcomes were overall succ...
41 CitationsSource
#2Rui MoraisH-Index: 6
Last. Guilherme MacedoH-Index: 23
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1 CitationsSource
#1Marc Bludau (University of Cologne)H-Index: 16
#2Hans F. Fuchs (University of Cologne)H-Index: 15
Last. Seung-Hun Chon (University of Cologne)H-Index: 13
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Background Esophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 200...
44 CitationsSource
Cited By1
#1Manon C.W. Spaander (EUR: Erasmus University Rotterdam)H-Index: 34
#2Ruben D. van der Bogt (EUR: Erasmus University Rotterdam)H-Index: 3
Last. Jeanin E. van Hooft (LUMC: Leiden University Medical Center)H-Index: 6
view all 17 authors...
MALIGNANT DISEASE 1: ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 : ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3: ESGE r...