1
|
Jung CFM, Binda C, Tuccillo L, Secco M, Gibiino G, Liverani E, Petraroli C, Coluccio C, Fabbri C. New Endoscopic Devices and Techniques for the Management of Post-Sleeve Gastrectomy Fistula and Gastric Band Migration. J Clin Med 2024; 13:4877. [PMID: 39201020 PMCID: PMC11355382 DOI: 10.3390/jcm13164877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Post-sleeve gastrectomy fistulas are a rare but possibly severe life-threatening complication. Besides early reoperation and drainage, endoscopy is the main treatment option. According to the clinical setting, endoscopic treatment options comprise stent or clip placement. New endoscopic therapies have recently gained attention, including endoscopic vacuum therapy, VacStent therapy, endoscopic internal drainage with pigtail stents, endoscopic suturing and stem cell injection. In this narrative review, we shed light on recent literature, developments, indications and contraindications of these treatments. Intragastric gastric band migration is a rare complication after gastric band positioning. Reoperation can sometimes be difficult, especially when a gastric band has already migrated far into the stomach. Endoscopic retrieval can be a valid, non-invasive therapeutic solution. We reviewed the current literature on this matter.
Collapse
Affiliation(s)
- Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Richter F, Conrad C, Hoffmann J, Reichert B, von Schoenfels W, Schafmayer C, Egberts JH, Becker T, Ellrichmann M. Endoluminal Vacuum Therapy Using a New "Fistula Sponge" in Treating Defects of the Upper Gastrointestinal Tract-A Comparative, Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1105. [PMID: 39064534 PMCID: PMC11279286 DOI: 10.3390/medicina60071105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Anastomotic insufficiencies (AI) and perforations of the upper gastrointestinal tract (uGIT) result in high morbidity and mortality. Endoscopic stent placement and endoluminal vacuum therapy (EVT) have been established as surgical revision treatment options. The Eso-Sponge® is the only licensed EVT system with limitations in treating small defects (<10 mm). Therefore, a fistula sponge (FS) was developed for the treatment of such defects as a new therapeutic approach. The aim of this study was to evaluate both EVT options' indications, success rates, and complications in a retrospective, comparative approach. Materials and Methods: Between 01/2018 and 01/2021, the clinical data of patients undergoing FS-EVT or conventional EVT (cEVT; Eso-Sponge®, Braun Melsungen, Melsungen, Germany) due to AI/perforation of the uGIT were recorded. Indication, diameter of leakage, therapeutic success, and complications during the procedure were assessed. FSs were prepared using a nasogastric tube and a porous drainage film (Suprasorb® CNP, Lohmann & Rauscher, Rengsdorf, Germany) sutured to the distal tip. Results: A total of 72 patients were included (20 FS-EVT; 52 cEVT). FS-EVT was performed in 60% suffering from AI (cEVT = 68%) and 40% from perforation (cEVT = 32%; p > 0.05). FS-EVT's duration was significantly shorter than cEVT (7.6 ± 12.0 d vs. 15.1 ± 14.3 d; p = 0.014). The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT (p < 0.001). Therapeutic success was achieved in 90% (FS-EVT) and 91% (cEVT; p > 0.05). Conclusions: EVT comprises an efficient treatment option for transmural defects of the uGIT. In daily clinical practice, fistulas < 10 mm with large abscess formations poses a special challenge since intraluminal cEVT usually is ineffective. In these cases, the concept of extraluminal FS placement is safe and effective.
Collapse
Affiliation(s)
- Florian Richter
- Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany; (F.R.); (J.H.); (B.R.); (W.v.S.); (T.B.)
| | - Claudio Conrad
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany;
| | - Julia Hoffmann
- Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany; (F.R.); (J.H.); (B.R.); (W.v.S.); (T.B.)
| | - Benedikt Reichert
- Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany; (F.R.); (J.H.); (B.R.); (W.v.S.); (T.B.)
| | - Witigo von Schoenfels
- Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany; (F.R.); (J.H.); (B.R.); (W.v.S.); (T.B.)
| | - Clemens Schafmayer
- Department of General Surgery, University Hospital Rostock, 18057 Rostock, Germany;
| | | | - Thomas Becker
- Department of General, Visceral-, Thoracic-, Transplantation- and Paediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany; (F.R.); (J.H.); (B.R.); (W.v.S.); (T.B.)
| | - Mark Ellrichmann
- Department of Internal Medicine I, University Medical Centre Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany;
| |
Collapse
|
3
|
Matteo MV, Birligea MM, Bove V, Pontecorvi V, De Siena M, Gualtieri L, Barbaro F, Spada C, Boškoski I. Management of fistulas in the upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 2024; 70:101929. [PMID: 39053982 DOI: 10.1016/j.bpg.2024.101929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Abstract
Fistulas in the upper gastrointestinal (GI) tract are complex conditions associated with elevated morbidity and mortality. They may arise as a result of inflammatory or malignant processes or following medical procedures, including endoscopic and surgical interventions. The management of upper GI is often challenging and requires a multidisciplinary approach. Accurate diagnosis, including endoscopic and radiological evaluations, is crucial to build a proper and personalized therapeutic plan, that should take into account patient's clinical conditions, time of onset, size, and anatomical characteristics of the defect. In recent years, several endoscopic techniques have been introduced for the minimally invasive management of upper GI fistulas, including through-the-scope and over-the-scope clips, stents, endoscopic suturing, endoluminal vacuum therapy (EVT), tissue adhesives, endoscopic internal drainage. This review aims to discuss and detail the current available endoscopic techniques for the treatment of upper GI fistulas.
Collapse
Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
| | | | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Loredana Gualtieri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Sapienza University of Rome, 00161, Rome, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Roma, Italy; Università Cattolica del Sacro Cuore, 00168, Roma, Italy
| |
Collapse
|
4
|
Gala K, Brunaldi V, Abu Dayyeh BK. Endoscopic Management of Surgical Complications of Bariatric Surgery. Gastroenterol Clin North Am 2023; 52:719-731. [PMID: 37919023 DOI: 10.1016/j.gtc.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Bariatric surgery, although highly effective, may lead to several surgical complications like ulceration, strictures, leaks, and fistulas. Newer endoscopic tools have emerged as safe and effective therapeutic options for these conditions. This article reviews post-bariatric surgery complications and the role of endoscopy in their management.
Collapse
Affiliation(s)
- Khushboo Gala
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Vitor Brunaldi
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
| |
Collapse
|
5
|
Medas R, Rodrigues-Pinto E. Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review. Clin Endosc 2023; 56:693-705. [PMID: 37430398 PMCID: PMC10665610 DOI: 10.5946/ce.2023.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 07/12/2023] Open
Abstract
Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.
Collapse
Affiliation(s)
- Renato Medas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| |
Collapse
|
6
|
de Moura DTH, Hirsch BS, McCarty TR, Lera Dos Santos ME, Guedes HG, Gomes GF, de Medeiros FS, de Moura EGH. Homemade endoscopic vacuum therapy device for the management of transmural gastrointestinal defects. Dig Endosc 2023; 35:745-756. [PMID: 36651679 DOI: 10.1111/den.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Endoscopic vacuum therapy (EVT) possesses a unique mechanism of action providing a less invasive alternative for the management of transmural gastrointestinal defects (TGID). This study evaluates the efficacy and safety of a novel homemade EVT (H-EVT) for the treatment of TGID. METHODS Retrospective multicenter study including patients who underwent H-EVT for TGID between January 2019 and January 2022. Main outcomes included technical and clinical success as well as safety outcomes. Subgroup analyses were included by defect location and classification. Logistic regression analyses were performed to determine predictors for successful closure. RESULTS A total of 144 patients were included. Technical success was achieved in all patients, with clinical success achieved in 88.89% after a mean of 3.49 H-EVT exchanges over an average of 23.51 days. After excluding 10 cases wherein it was not possible to achieve negative pressure, successful closure occurred in 95.52% of patients. Time to clinical success was less for defects caused by endoscopic (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.33-1.20) compared to surgical procedures and for patients with simultaneous intracavitary and intraluminal H-EVT placement (HR 0.70; 95% CI 0.55-0.91). Location and classification of defect did not impact clinical success rate. Simultaneous placement of both an intraluminal and intracavitary H-EVT (odds ratio 3.08; 95% CI 1.19-7.95) was a significant predictor of clinical success. Three device-related adverse events (2.08%) occurred. CONCLUSIONS The use of the H-EVT is feasible, safe, and effective for the management of TGID.
Collapse
Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital São Luiz Morumbi, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Salomão Hirsch
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thomas R McCarty
- Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, USA
| | - Marcos Eduardo Lera Dos Santos
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital São Luiz Jabaquara, São Paulo, Brazil
| | - Hugo Gonçalo Guedes
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Santa Luzia, Brasilia, Brazil
| | | | | | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Instituto D´Or de Pesquisa e Ensino, Hospital São Luiz Morumbi, São Paulo, Brazil
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Fuentes KMI, Seastedt KP, Kidane B, Servais EL. Advanced Endoscopy for Thoracic Surgeons. Thorac Surg Clin 2023; 33:251-263. [PMID: 37414481 DOI: 10.1016/j.thorsurg.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The thoracic surgeon, well versed in advanced endoscopy, has an array of therapeutic options for foregut pathologic conditions. Peroral endoscopic myotomy (POEM) offers a less-invasive means to treat achalasia, and the authors' preferred approach is described in this article. They also describe variations of POEM, such as G-POEM, Z-POEM, and D-POEM. In addition, endoscopic stenting, endoluminal vacuum therapy, endoscopic internal drainage, and endoscopic suturing/clipping are discussed and can be valuable tools for esophageal leaks and perforations. Endoscopic procedures are advancing rapidly, and thoracic surgeons must maintain at the forefront of these technologies.
Collapse
Affiliation(s)
- Kathleen M I Fuentes
- Department of General Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | - Kenneth P Seastedt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Biniam Kidane
- Department of Surgery, University of Manitoba, Room GE-611, 820 Sherbook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Elliot L Servais
- Division of Thoracic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
| |
Collapse
|
8
|
Kouladouros K. Applications of endoscopic vacuum therapy in the upper gastrointestinal tract. World J Gastrointest Endosc 2023; 15:420-433. [PMID: 37397978 PMCID: PMC10308278 DOI: 10.4253/wjge.v15.i6.420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the treatment of anastomotic leaks after esophageal and gastric surgery, it was also implemented for a wide range of defects, including acute perforations, duodenal lesions, and postbariatric complications. Apart from the initially proposed handmade sponge inserted using the “piggyback” technique, further devices were used, such as the commercially available EsoSponge and VAC-Stent as well as open-pore film drainage. The reported pressure settings and intervals between the subsequent endoscopic procedures vary greatly, but all available evidence highlights the efficacy of EVT, with high success rates and low morbidity and mortality, so that in many centers it is considered to be a first-line treatment, especially for anastomotic leaks.
Collapse
Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Surgical Clinic, Mannheim University Hospital, University of Heidelberg, Mannheim 68167, Baden-Wuerttemberg, Germany
| |
Collapse
|
9
|
Mandarino FV, Barchi A, D’Amico F, Fanti L, Azzolini F, Viale E, Esposito D, Rosati R, Fiorino G, Bemelman WA, Elmore U, Barbieri L, Puccetti F, Testoni SGG, Danese S. Endoscopic Vacuum Therapy (EVT) versus Self-Expandable Metal Stent (SEMS) for Anastomotic Leaks after Upper Gastrointestinal Surgery: Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:287. [PMID: 36836644 PMCID: PMC9968149 DOI: 10.3390/life13020287] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Endoscopic treatment of post-esophagectomy/gastrectomy anastomotic dehiscence includes Self-Expandable Metal Stents (SEMS), which have represented the "gold standard" for many years, and Endoscopic Vacuum Therapy (EVT), which was recently introduced, showing promising results. The aim of the study was to compare outcomes of SEMS and EVT in the treatment of post-esophagectomy/gastrectomy anastomotic leaks, focusing on oncologic surgery. METHODS A systematic search was performed on Pubmed and Embase, identifying studies comparing EVT versus SEMS for the treatment of leaks after upper gastro-intestinal surgery for malignant or benign pathologies. The primary outcome was the rate of successful leak closure. A meta-analysis was conducted, performing an a priori-defined subgroup analysis for the oncologic surgery group. RESULTS Eight retrospective studies with 357 patients were eligible. Overall, the EVT group showed a higher success rate (odd ratio [OR] 2.58, 95% CI 1.43-4.66), a lower number of devices (pooled mean difference [pmd] 4.90, 95% CI 3.08-6.71), shorter treatment duration (pmd -9.18, 95% CI -17.05--1.32), lower short-term complication (OR 0.35, 95% CI 0.18-0.71) and mortality rates (OR 0.47, 95% CI 0.24-0.92) compared to stenting. In the oncologic surgery subgroup analysis, no differences in the success rate were found (OR 1.59, 95% CI 0.74-3.40, I2 = 0%). CONCLUSIONS Overall, EVT has been revealed to be more effective and less burdened by complications compared to stenting. In the oncologic surgery subgroup analysis, efficacy rates were similar between the two groups. Further prospective data need to define a unique management algorithm for anastomotic leaks.
Collapse
Affiliation(s)
- Francesco Vito Mandarino
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Barchi
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ferdinando D’Amico
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Francesco Azzolini
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Edi Viale
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Dario Esposito
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Gionata Fiorino
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Willem Adrianus Bemelman
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Surgery, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Lavinia Barbieri
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Sabrina Gloria Giulia Testoni
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Silvio Danese
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| |
Collapse
|
10
|
Binda C, Jung CFM, Fabbri S, Giuffrida P, Sbrancia M, Coluccio C, Gibiino G, Fabbri C. Endoscopic Management of Postoperative Esophageal and Upper GI Defects-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010136. [PMID: 36676760 PMCID: PMC9864982 DOI: 10.3390/medicina59010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Anastomotic defects are deleterious complications after either oncologic or bariatric surgery, leading to high morbidity and mortality. Besides surgical revision in early stages or instable patients, endoscopic treatment has become the mainstay. To date, many options for endoscopic treatment in this setting exist, including fully covered metal stent placement, endoscopic vacuum therapy (EVT), endoscopic internal drainage with pigtail placement (EID), leak closure with through the scope or over the scope clips, endoluminal suturing, fibrin glue sealing and a combination of all these techniques. Current evidence is mostly based on retrospective single and multicenter studies. No guidelines exist in this important field. Treatment options have to be chosen upon each case individually, taking into account clinical and anatomic criteria, such as timing, size, infectious wound complications and hemodynamic stability. Local expertise and availability of treatment devices need to be taken into account whenever choosing a treatment strategy. This review aimed to present current treatment options in terms of effectiveness, advantages and disadvantages in order to guide the clinician for his decision making. Additionally, we aimed to provide a treatment algorithm.
Collapse
Affiliation(s)
- Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
- Correspondence:
| | - Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Paolo Giuffrida
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forli—Cesena Hospitals, AUSL Romagna, 47121 Forlì Cesena, Italy
| |
Collapse
|
11
|
Jung CFM, Hallit R, Müller-Dornieden A, Calmels M, Goere D, Chaput U, Camus M, Gonzalez JM, Barthet M, Jacques J, Legros R, Barrioz T, Kück F, Seif Amir Hosseini A, Ghadimi M, Kunsch S, Ellenrieder V, Wedi E, Barret M. Reply to Danese et al. Endoscopy 2023; 55:101. [PMID: 36538923 DOI: 10.1055/a-1901-8750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Carlo Felix Maria Jung
- Department of Gastroenterology and Digestive Endoscopy, Forli-Cesena Hospitals, AUSL Romagna, Italy.,Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Rachel Hallit
- Department of Gastroenterology and Gastrointestinal Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Annegret Müller-Dornieden
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Mélanie Calmels
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Diane Goere
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Ulriikka Chaput
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Marine Camus
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Jean Michel Gonzalez
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Thierry Barrioz
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Fabian Kück
- Department of Medical Statistics, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Kunsch
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany.,Department of Gastroenterology, Internal Medicine and Geriatrics, Rems-Murr Hospital, Winnenden, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Edris Wedi
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany.,Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach, Offenbach, Germany
| | - Maximilien Barret
- Department of Gastroenterology and Gastrointestinal Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| |
Collapse
|
12
|
Chon SH, Brunner S, Müller DT, Lorenz F, Stier R, Streller L, Eckhoff J, Straatman J, Babic B, Schiffmann LM, Schröder W, Schmidt T, Bruns CJ, Fuchs HF. Time to endoscopic vacuum therapy-lessons learned after > 150 robotic-assisted minimally invasive esophagectomies (RAMIE) at a German high-volume center. Surg Endosc 2023; 37:741-748. [PMID: 36344896 PMCID: PMC9640783 DOI: 10.1007/s00464-022-09754-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE OF THE STUDY In esophageal surgery, anastomotic leak (AL) remains one of the most severe and critical adverse events after oncological esophagectomy. Endoscopic vacuum therapy (EVT) can be used to treat AL; however, in the current literature, treatment outcomes and reports on how to use this novel technique are scarce. The aim of this study was to evaluate the outcomes of patients with an AL after IL RAMIE and to determine whether using EVT as an treatment option is safe and feasible. MATERIAL AND METHODS This study includes all patients who developed an Esophagectomy Complications Consensus Group (ECCG) type II AL after IL RAMIE at our center between April 2017 and December 2021. The analysis focuses on time to EVT, duration of EVT, and follow up treatments for these patients. RESULTS A total of 157 patients underwent an IL RAMIE at our hospital. 21 patients of these (13.4%) developed an ECCG type II AL. One patient died of unrelated Covid-19 pneumonia and was excluded from the study cohort. The mean duration of EVT was 12 days (range 4-28 days), with a mean of two sponge changes (range 0-5 changes). AL was diagnosed at a mean of 8 days post-surgery (range 2-16 days). Closure of the AL with EVT was successful in 15 out of 20 patients (75%). Placement of a SEMS (Self-expandlable metallic stent) after EVT was performed in four patients due to persisting AL. Overall success rate of anastomotic sealing independently of the treatment modality was achieved in 19 out of 20 Patients (95%). No severe EVT-related adverse events occurred. CONCLUSION This study shows that EVT can be a safe and effective endoscopic treatment option for ECCG type II AL.
Collapse
Affiliation(s)
- Seung-Hun Chon
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Stefanie Brunner
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Dolores T Müller
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Florian Lorenz
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Raphael Stier
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Lea Streller
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Jennifer Eckhoff
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Jennifer Straatman
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Benjamin Babic
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Lars M Schiffmann
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Wolfgang Schröder
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Thomas Schmidt
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Christiane J Bruns
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Hans F Fuchs
- Interdisciplinary Endoscopy Unit, Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| |
Collapse
|
13
|
Mandarino FV, Barchi A, Fanti L, Azzolini F, Rosati R, Danese S. Endoscopic internal drainage versus endoscopic vacuum therapy for upper gastrointestinal leaks: what's the real deal? Endoscopy 2023; 55:100. [PMID: 36538922 DOI: 10.1055/a-1888-4116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Francesco V Mandarino
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Barchi
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Azzolini
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvio Danese
- Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
14
|
Klose MA, Walldorf J, Damm M, Krug S, Klose J, Ronellenfitsch U, Kleeff J, Michl P, Rosendahl J. Treatment of esophageal leakages with the Microtech ®-VAC-Stent: a monocentric early experience of three cases. Ther Adv Gastrointest Endosc 2023; 16:26317745231200312. [PMID: 37779920 PMCID: PMC10540572 DOI: 10.1177/26317745231200312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023] Open
Abstract
Background Endoscopic approaches in the treatment of transmural esophageal defects, either after esophageal resection or due to perforation, have demonstrated convincing feasibility. Surgical options are limited and associated with high morbidity and mortality rates. Currently, internal endoscopic drainage with pigtail stents, self-expanding metal stent (SEMS), or endoscopic vacuum therapy (EVT) are options for first-line treatment. Here, we report the outcome of the recently developed combination of SEMS and EVT using the endoscopic Microtech®-VAC-Stent (EVS). Methods Between June and July 2022, three consecutive patients (one female and two males) with esophageal transmural defects were treated with the Microtech®-VAC-Stent. Two patients suffered from an anastomotic leak after oncologic gastroesophageal surgery, and one patient presented with esophageal perforation due to Boerhaave syndrome. Results Three consecutive patients were successfully treated with EVS. In one patient, one EVS treatment was sufficient, whereas the other two patients needed two and six EVS exchanges. Exchanges were scheduled every 7 days and no procedural adverse events were observed. Conclusion In line with the former case series, EVS therapy is a promising new approach for the treatment of esophageal leaks. Exchange of the EVS seems feasible every 7 days reducing interventions for the individual patient. Prospective studies comparing EVS with other endoscopic therapies are needed to define the best therapeutic approach.
Collapse
Affiliation(s)
- Michelle A. Klose
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Jens Walldorf
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Marko Damm
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Sebastian Krug
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Johannes Klose
- Department of General, Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Ulrich Ronellenfitsch
- Department of General, Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Joerg Kleeff
- Department of General, Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Patrick Michl
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Saale, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120 Halle, Saale, Germany
| |
Collapse
|
15
|
Jung DH, Park JC. Response. Gastrointest Endosc 2022; 96:873-874. [PMID: 36270705 DOI: 10.1016/j.gie.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/08/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Da Hyun Jung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
16
|
Mandarino FV, Barchi A, Fanti L, Azzolini F, Rosati R, Danese S. Endoscopic vacuum therapy in the treatment of postesophagectomy leaks: Is intracavitary the way? Gastrointest Endosc 2022; 96:873. [PMID: 36270706 DOI: 10.1016/j.gie.2022.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Francesco Vito Mandarino
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Barchi
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorella Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Azzolini
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvio Danese
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
17
|
Endoscopic vacuum therapy for post-esophagectomy anastomotic dehiscence as rescue treatment: a single center case series. Esophagus 2022; 19:417-425. [PMID: 35347509 DOI: 10.1007/s10388-022-00912-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/18/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic vacuum therapy (EVT) represents an effective endoscopic technique for the treatment of post-esophagectomy leaks and can be used after failure of primary treatment. We aimed to investigate endoscopic data and success rate of EVT for post-esophagectomy anastomotic leaks, after failed redo surgery or previous endoscopic treatment. METHODS We retrospectively recruited 12 patients from January 2018 to October 2020. Success was defined as dehiscence closure at radiological and/or endoscopic evaluation. Ethical Committee of our institution approved the study. RESULTS Twelve patients (66.7% male, mean age 65.08 ± 16.7 years) affected by esophago-gastric (n = 10) or esophago-jejunal (n = 2) anastomosis dehiscences after oncologic surgery were treated with EVT, after failure of previous redo-surgical (n = 3, 25%) or endoscopic management (n = 9, 75%). Technical success rate was 100% (60/60 procedures) and dehiscence closure was achieved in three quarters of patients (9/12, 75%). Regarding complications, one case of sponge dislocation (1/60 = 1.7%) and another case of delayed stricture after post-EVT stent placement (1/60 = 1.7%) were recorded, during a mean follow up of 182.3 days. CONCLUSIONS EVT is a promising option in the treatment of the most complicated anastomotic dehiscences. Its use could be also considered after failure of previous endoscopic or surgical management.
Collapse
|
18
|
Nutritional Support and Duration of Drainage Recommendations for Endoscopic Internal Drainage: Review of the Literature and Initial Experience. Obes Surg 2022; 32:1421-1427. [PMID: 35218510 DOI: 10.1007/s11695-022-05978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Anastomotic leaks following foregut surgery pose a difficult scenario for surgeons. While definitive surgical options are more invasive and may result in diversion requiring subsequent surgeries, endoscopic management of these leaks has been shown to work as an alternative platform for management. An evolving option is endoscopic internal drainage. We have reviewed our experience using endoscopic internal drainage and report our outcomes. MATERIALS AND METHODS An institution review board approved prospectively gathered database was used to identify all patients undergoing endoscopic internal drainage following esophageal and gastric leaks. Patient demographics, sentinel operation causing the leak, and outcomes of therapy were collected. The rate of healing and complications with the drainage catheter in place were the primary endpoints. RESULTS Sixteen patients were identified (5 male, 11 female) that underwent endoscopic internal drainage with a mean age of 48 and mean BMI of 30.8. Overall success rate was 69% (11/16), where 4 patients required a definitive surgery, and one healed with endoluminal vacuum therapy. Of the 4 failures, 1 patient required esophagojejunostomy, 2 patients required a fistulojejunostomy, and one required a partial gastrectomy. A total of 12 patients (75%) had a prior endoscopic procedure that was unsuccessful. The mean duration of drainage catheter in place was 48 days. While the catheter was in place, 4 patients were allowed minimal PO intake in conjunction with total parenteral nutrition or tube feeds. The rest of the patients were strict NPO with other means of nutrition. There were no complications with the drainage catheters and no deaths. CONCLUSION Leaks following esophagogastric surgery are difficult to manage; however, endoscopic internal drainage has been shown to be effective. Duration of the technique should be around 6 to 8 weeks with nutritional support guided by the comfort of the managing clinician.
Collapse
|
19
|
Toh BC, Chong J, Yeung BP, Lim CH, Lim EK, Chan WH, Tan JT. Endoscopic Internal Drainage with Double Pigtail Stents for Upper Gastrointestinal Anastomotic Leaks: Suitable for All Cases? Clin Endosc 2022; 55:401-407. [PMID: 34986605 PMCID: PMC9178146 DOI: 10.5946/ce.2021.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining ten patients, nine (90%) did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the first week and a soft diet in the second week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.
Collapse
Affiliation(s)
- Bin Chet Toh
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Jingli Chong
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Baldwin Pm Yeung
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Eugene Kw Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Th Tan
- Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
20
|
Hallit R, Calmels M, Chaput U, Lorenzo D, Becq A, Camus M, Dray X, Gonzalez JM, Barthet M, Jacques J, Barrioz T, Legros R, Belle A, Chaussade S, Coriat R, Cattan P, Prat F, Goere D, Barret M. Endoscopic management of anastomotic leak after esophageal or gastric resection for malignancy: a multicenter experience. Therap Adv Gastroenterol 2021; 14:17562848211032823. [PMID: 35154387 PMCID: PMC8832292 DOI: 10.1177/17562848211032823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/25/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. METHODS We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. RESULTS Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6-13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively (p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage (p = 0.002). CONCLUSION Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.
Collapse
Affiliation(s)
| | - Mélanie Calmels
- Digestive Surgery Department, St Louis
University Hospital, Assistance Publique Hôpitaux de Paris and University of
Paris, Paris, France
| | - Ulriikka Chaput
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Diane Lorenzo
- Gastroenterology Department, Beaujon University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Aymeric Becq
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Marine Camus
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Jean Michel Gonzalez
- Gastroenterology Department, North Hospital,
Assistance Publique – Hôpitaux de Marseille and University of Aix-Marseille,
Marseille, France
| | - Marc Barthet
- Gastroenterology Department, North Hospital,
Assistance Publique – Hôpitaux de Marseille and University of Aix-Marseille,
Marseille, France
| | - Jérémie Jacques
- Gastroenterology Department, Limoges
University Hospital, and University Limoges, Limoges, France
| | - Thierry Barrioz
- Gastroenterology Department, Poitiers
University Hospital, Poitiers, France
| | - Romain Legros
- Gastroenterology Department, Limoges
University Hospital, and University Limoges, Limoges, France
| | - Arthur Belle
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Romain Coriat
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Pierre Cattan
- Digestive Surgery Department, St Louis
University Hospital, Assistance Publique Hôpitaux de Paris and University of
Paris, Paris, France
| | - Frédéric Prat
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Diane Goere
- Digestive Surgery Department, St Louis
University Hospital, Assistance Publique Hôpitaux de Paris and University of
Paris, Paris, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| |
Collapse
|