Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks

被引:12
作者
Rodrigues-Pinto, Eduardo [1 ]
Pereira, Pedro [1 ]
Sousa-Pinto, Bernardo [2 ,3 ]
Shehab, Hany [4 ]
Pinho, Rolando [5 ]
Larsen, Michael C. [6 ]
Irani, Shayan [6 ]
Kozarek, Richard A. [6 ]
Capogreco, Antonio [7 ]
Repici, Alessandro [7 ]
Shemmeri, Ealaf [8 ]
Louie, Brian E. [8 ]
Rogalski, Pawel [9 ]
Baniukiewicz, Andrzej [9 ]
Dabrowski, Andrzej [9 ]
de Sousa, Joao Correia [10 ]
Barrias, Silvia [10 ]
Ichkhanian, Yervant [11 ]
Kumbhari, Vivek [11 ]
Khashab, Mouen A. [11 ]
Bowers, Nicole [12 ]
Schulman, Allison R. [12 ]
Macedo, Guilherme [1 ]
机构
[1] Ctr Hosp Sao Joao, Gastroenterol Dept, P-4200319 Porto, Portugal
[2] Univ Porto, Fac Med, Dept Community Med Informat & Hlth Decis Sci, MEDCIDS, Porto, Portugal
[3] Ctr Hlth Technol & Serv Res, CINTESIS, Porto, Portugal
[4] Cairo Univ Hosp, Gastroenterol Dept, Cairo, Egypt
[5] Ctr Hosp Vila Nova de Gaia Espinho, Dept Gastroenterol, Vila Nova De Gaia, Portugal
[6] Virginia Mason Med Ctr, Dept Gastroenterol & Hepatol, Seattle, WA 98101 USA
[7] Humanitas Univ, Humanitas Res Hosp, Digest Endoscopy Unit, Milan, Italy
[8] Swedish Canc Inst, Div Thorac Surg, Seattle, WA USA
[9] Med Univ Bialystok, Dept Gastroenterol & Internal Med, Bialystok, Poland
[10] Ctr Hosp Porto, Dept Gastroenterol, Hosp Santo Antonio, Porto, Portugal
[11] Johns Hopkins Med Inst, Div Gastroenterol & Hepatol, Baltimore, MD 21205 USA
[12] Univ Michigan, Div Gastroenterol & Hepatol, Ann Arbor, MI USA
关键词
EXPANDABLE METAL STENTS; VACUUM-ASSISTED CLOSURE; ANASTOMOTIC LEAKAGE; SLEEVE GASTRECTOMY; BARIATRIC SURGERY; MANAGEMENT; ESOPHAGECTOMY; FISTULAS; THERAPY;
D O I
10.1016/j.gie.2020.10.015
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:1283 / +
页数:19
相关论文
共 34 条
[1]   Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience [J].
Anderloni, Andrea ;
Genco, Chiara ;
Massidda, Marco ;
Di Leo, Milena ;
Fumagalli, Uberto Romario ;
Rosati, Riccardo ;
Correale, Loredana ;
Maselli, Roberta ;
Ferrara, Elisa Chiara ;
Jovani, Manol ;
Repici, Alessandro .
DIGESTIVE SURGERY, 2019, 36 (04) :309-316
[2]   Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas [J].
Baptista, Alberto ;
De Moura, Diogo Turiani Hourneaux ;
Jirapinyo, Pichamol ;
De Moura, Eduardo Guimaraes Hourneaux ;
Gelrud, Andres ;
Kahaleh, Michel ;
Salinas, Alberto ;
Carlos Sabagh, Luis ;
Ospina, Andres ;
Zambrano Rincones, Victor ;
Doval, Raul ;
Bandel, Jack William ;
Thompson, Christopher C. .
GASTROINTESTINAL ENDOSCOPY, 2019, 89 (04) :671-+
[3]   An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study [J].
Bege, Thierry ;
Emungania, Olivier ;
Vitton, Veronique ;
Ah-Soune, Philippe ;
Nocca, David ;
Noel, Patrick ;
Bradjanian, Sarah ;
Berdah, Stephane V. ;
Brunet, Christian ;
Grimaud, Jean-Charles ;
Barthet, Marc .
GASTROINTESTINAL ENDOSCOPY, 2011, 73 (02) :238-244
[4]   Reporting of Short-Term Clinical Outcomes After Esophagectomy A Systematic Review [J].
Blencowe, Natalie S. ;
Strong, Sean ;
McNair, Angus G. K. ;
Brookes, Sara T. ;
Crosby, Tom ;
Griffin, S. Michael ;
Blazeby, Jane M. .
ANNALS OF SURGERY, 2012, 255 (04) :658-666
[5]   Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks [J].
Bludau, Marc ;
Fuchs, Hans F. ;
Herbold, Till ;
Maus, Martin K. H. ;
Alakus, Hakan ;
Popp, Felix ;
Leers, Jessica M. ;
Bruns, Christiane J. ;
Hoelscher, Arnulf H. ;
Schroeder, Wolfgang ;
Chon, Seung-Hun .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2018, 32 (04) :1906-1914
[6]   Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis [J].
Brangewitz, M. ;
Voigtlaender, T. ;
Helfritz, F. A. ;
Lankisch, T. O. ;
Winkler, M. ;
Klempnauer, J. ;
Manns, M. P. ;
Schneider, A. S. ;
Wedemeyer, J. .
ENDOSCOPY, 2013, 45 (06) :433-438
[7]   Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study [J].
Christophorou, Dimitri ;
Valats, Jean-Christophe ;
Funakoshi, Natalie ;
Duflos, Claire ;
Picot, Marie-Chistine ;
Vedrenne, Bruno ;
Prat, Frederic ;
Bulois, Phillipe ;
Branche, Julien ;
Decoster, Sebastien ;
Coron, Emmanuel ;
Charachon, Antoine ;
De Chambrun, Guillaume Pineton ;
Nocca, David ;
Bauret, Paul ;
Blanc, Pierre .
ENDOSCOPY, 2015, 47 (11) :988-996
[8]   Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes [J].
El Hajj, Ihab I. ;
Imperiale, Thomas F. ;
Rex, Douglas K. ;
Ballard, Darren ;
Kesler, Kenneth A. ;
Birdas, Thomas J. ;
Fatima, Hala ;
Kessler, William R. ;
DeWitt, John M. .
GASTROINTESTINAL ENDOSCOPY, 2014, 79 (04) :589-598
[9]   Indication for 'Over the Scope' (OTS)-Clip vs. Covered Self-Expanding Metal Stent (cSEMS) Is Unequal in Upper Gastrointestinal Leakage: Results from a Retrospective Head-to-Head Comparison [J].
Farnik, Harald ;
Driller, Marlene ;
Kratt, Thomas ;
Schmidt, Carsten ;
Faehndrich, Martin ;
Filmann, Natalie ;
Koenigsrainer, Alfred ;
Stallmach, Andreas ;
Heike, Michael ;
Bechstein, Wolf O. ;
Zeuzem, Stefan ;
Albert, Joerg G. .
PLOS ONE, 2015, 10 (01)
[10]   Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity [J].
Gonzalez, Rodrigo ;
Sarr, Michael G. ;
Smith, C. Daniel ;
Baghai, Mercedeh ;
Kendrick, Michael ;
Szomstein, Samuel ;
Rosenthal, Raul ;
Murr, Michel M. .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2007, 204 (01) :47-55