International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks

被引:31
作者
Rodrigues-Pinto, Eduardo [1 ]
Repici, Alessandro [2 ,3 ]
Donatelli, Gianfranco [4 ]
Macedo, Guilherme [1 ]
Deviere, Jacques [5 ]
van Hooft, Jeanin E. [6 ]
Campos, Josemberg M. [7 ]
Neto, Manoel Galvao [8 ]
Silva, Marco [1 ]
Eisendrath, Pierre [9 ]
Kumbhari, Vivek [10 ,11 ]
Khashab, Mouen A. [10 ,11 ]
Mathew, Abraham [12 ]
Fernandez Villaverde, Alberto [13 ]
Guerron, Alfredo Daniel [14 ]
Tringali, Andrea [15 ]
Vermeulen, Bram [16 ]
Louie, Brian [17 ,18 ]
Meduri, Bruno [19 ]
Luigiano, Carmelo [20 ]
Gubler, Christoph [21 ]
Lorenzo, Diane [22 ]
Pauli, Eric M. [12 ]
Baretta, Giorgio [23 ]
Raju, Gottumukkala S. [24 ,25 ]
Loske, Gunnar [26 ]
Pines, Guy [27 ,28 ]
El Mourad, Haicam [29 ]
Shehab, Hany [30 ]
Kobara, Hideki [31 ]
Lee, Hyuk [32 ]
Chung, Hyunsoo [33 ,34 ]
Lai, I-Rue [35 ]
Rouvelas, Ioannis [36 ,37 ]
Gonzalez, Jean-Michel [22 ]
Gornals, Joan B. [38 ]
Wedemeyer, Jochen [39 ]
DeWitt, John M. [40 ]
Cho, Joo Young [41 ]
Kotzampassi, Katerina [42 ]
Chen, Ke-Neng [43 ]
Swanstrom, Lee L. [44 ]
Almadi, Majid A. [45 ]
Barthet, Marc [22 ]
Alvarez-Sanchez, Maria-Victoria [46 ]
Shnell, Mati [47 ]
Schweitzer, Michael A. [48 ]
Sulz, Michael Christian [49 ]
Sarr, Michael G. [50 ]
Talbot, Michael [51 ]
机构
[1] Ctr Hosp Sao Joao, Gastroenterol Dept, Porto Al Prof Hernani Monteiro 4200-319, Porto, Portugal
[2] Humanitas Res Hosp, Digest Endoscopy Unit, Milan, Italy
[3] Humanitas Univ, Milan, Italy
[4] Hop Prive Peupliers Paris, Dept Gastroenterol & Hepatol, Paris, France
[5] Univ Libre Bruxelles, Erasme Univ Hosp, Dept Gastroenterol Hepatopancreatol & Digest Onco, Brussels, Belgium
[6] Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands
[7] Univ Pernambuco, Dept Surg, Recife, PE, Brazil
[8] Florida Int Univ, Herbert Wertheim Coll Med, Dept Surg, Miami, FL 33199 USA
[9] Univ Libre Bruxelles, Dept Gastroenterol & Hepatol, CHU St Pierre, Brussels, Belgium
[10] Johns Hopkins Med Inst, Dept Med, Baltimore, MD 21205 USA
[11] Johns Hopkins Med Inst, Div Gastroenterol & Hepatol, Baltimore, MD 21205 USA
[12] Penn State Milton S Hershey Med Ctr, Dept Surg, Sect Minimally Invas & Bariatr Surg, Hershey, PA USA
[13] POVISA Hosp, Gastroenterol Dept, Vigo, Pontevedra, Spain
[14] Duke Univ, Dept Surg, Div Metab & Weight Loss Surg, Durham, NC USA
[15] Catholic Univ, Fdn Policlin Univ A Gemelli, IRCCS, Digest Endoscopy Unit, Rome, Italy
[16] Radboud Univ Nijmegen, Med Ctr, Dept Gastroenterol & Hepatol, Nijmegen, Netherlands
[17] Swedish Canc Inst, Div Thorac Surg, Seattle, WA USA
[18] Med Ctr, Seattle, WA USA
[19] Hop Prive Peupliers, Dept Gastroenterol & Hepatol, Paris, France
[20] San Paolo Hosp, Digest Endoscopy Unit, Milan, Italy
[21] Univ Hosp Zurich, Div Gastroenterol & Hepatol, Zurich, Switzerland
[22] Aix Marseille Univ, Hop Nord, AP HM, Dept Gastroenterol, Marseille, France
[23] Univ Fed Parana, Curitiba, Parana, Brazil
[24] Univ Texas Houston, Grad Sch Biomed Sci, Houston, TX USA
[25] MD Anderson Canc Ctr, Houston, TX USA
[26] Kathol Marienkrankenhaus Hamburg gGmbH, Dept Gen Abdominal Thorac & Vasc Surg, Hamburg, Germany
[27] Kaplan Med Ctr, Dept Surg, Rehovot, Israel
[28] Hebrew Univ Jerusalem, Sch Med, Jerunited Stateslem, Israel
[29] AZ Sint Blasius Med Ctr, Dept Bariatr Surg, Dendermonde, Belgium
[30] Cairo Univ, Dept Gastroenterol, Gastrointestinal Endoscopy Unit, Cairo, Egypt
[31] Kagawa Univ, Fac Med, Dept Gastroenterol & Neurol, Takamatsu, Kagawa, Japan
[32] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Med, Seoul, South Korea
[33] Seoul Natl Univ, Coll Med, Dept Internal Med, Div Gastroenterol, Seoul, South Korea
[34] Seoul Natl Univ, Coll Med, Liver Res Inst, Seoul, South Korea
[35] Natl Taiwan Univ Hosp, Dept Surg, Taipei, Taiwan
[36] Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden
[37] Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Div Surg, Stockholm, Sweden
[38] Univ Barcelona, Hosp Univ Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Endoscopy Unit,Dept Digest Dis, Barcelona, Spain
[39] Med Sch Hannover, Dept Gastroenterol Hepatol & Endocrinol, Hannover, Germany
[40] Indiana Univ, Div Gastroenterol & Hepatol, Indianapolis, IN 46204 USA
[41] Cha Univ, Coll Med, Cha Bundang Med Ctr, Dept Gastroenterol, Seongnam Si, South Korea
[42] Aristotle Univ Thessaloniki, AHEPA Hosp, Dept Surg, Thessaloniki, Greece
[43] Beijing Univ, Canc Hosp, Dept Thorac Surg 1, Beijing, Peoples R China
[44] Oregon Clin, Gastrointestinal & Minimally Invas Surg, Portland, OR USA
[45] King Saud Univ, King Khalid Univ Hosp, Div Gastroenterol, Riyadh, Saudi Arabia
[46] Complejo Hosp Pontevedra, Dept Gastroenterol, Pontevedra, Spain
[47] Tel Aviv Univ, Sackler Sch Med, Tel Aviv Med Ctr, Obes Serv,Dept Gastroenterol & Liver Dis, Tel Aviv, Israel
[48] Johns Hopkins Med Inst, Dept Surg, Baltimore, MD 21205 USA
[49] Kantonsspital St Gallen, Div Gastroenterol, St Gallen, Switzerland
[50] Mayo Clin, Dept Gastroenterol & Gen Surg, Rochester, MN USA
关键词
PARADIGM SHIFT; MANAGEMENT; SURGERY;
D O I
10.1055/a-1005-6632
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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; 69 % were from gastroenterologists and 56 % had > 10 years of experience. A third of respondents treat between 10 and 19 patients annually. Fifty-six percent use fully-covered self-expandable metal stents as their usual first option; 80% use techniques to minimize migration; 4 weeks was the most common reported stent dwell time. Sixty percent perform epithelial ablation prior to over-the-scope-clip placement or suturing. Regarding endoscopic vacuum therapy (EVT), 56 % perform balloon dilation and intracavitary EVT in patients with large cavities but small leak defects. Regarding endoscopic septotomy, 56 % consider a minimal interval of 4 weeks from surgery and 90 % consider the need to perform further sessions. Regarding endoscopic internal drainage (EID), placement of two stents and shorter stents is preferred. Persistent inflammation with clinical sepsis was the definition most commonly reported for endoscopic failure. EVT/stent placement and EVT/EID were the therapeutic options most often chosen in patients with previous oncologic surgery and previous bariatric surgery, respectively. Conclusions There is a wide variation in the management of patients with UGI anastomotic leaks. Future prospective studies are needed to move from an expert- to evidence- and personalization-based care.
引用
收藏
页码:E1671 / E1682
页数:12
相关论文
共 16 条
[1]   Endoscopic Management of Transmural Defects, Including Leaks, Perforations, and Fistulae [J].
Bemelman, Willem A. ;
Baron, Todd H. .
GASTROENTEROLOGY, 2018, 154 (07) :1938-+
[2]   Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration [J].
Bick, Benjamin L. ;
Imperiale, Thomas F. ;
Johnson, Cynthia S. ;
DeWitt, John M. .
GASTROINTESTINAL ENDOSCOPY, 2017, 86 (06) :1015-1021
[3]   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
[4]  
Cho Jaehoon, 2018, Gastrointest Endosc Clin N Am, V28, P233, DOI 10.1016/j.giec.2017.11.010
[5]   Endoscopic Management of Benign Esophageal Ruptures and Leaks [J].
Milena Di Leo ;
Roberta Maselli ;
Elisa Chiara Ferrara ;
Laura Poliani ;
Sameer Al Awadhi ;
Alessandro Repici .
Current Treatment Options in Gastroenterology, 2017, 15 (2) :268-284
[6]   Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series [J].
Donatelli, Gianfranco ;
Dumont, Jean-Loup ;
Cereatti, Fabrizio ;
Dhumane, Parag ;
Tuszynski, Thierry ;
Vergeau, Bertrand Marie ;
Meduri, Bruno .
ENDOSCOPY INTERNATIONAL OPEN, 2016, 4 (06) :E647-E651
[7]   Digestive leaks: An approach tailored to both indication and anatomy [J].
Eisendrath, Pierre ;
Deviere, Jacques .
ENDOSCOPY INTERNATIONAL OPEN, 2016, 4 (06) :E652-E653
[8]   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
[9]   Keeping the fistula open: paradigm shift in the management of leaks after bariatric surgery? [J].
Kumbhari, Vivek ;
Abu Dayyeh, Barham K. .
ENDOSCOPY, 2016, 48 (09) :789-791
[10]   Endoscopic management of bariatric surgical complications [J].
Kumbhari, Vivek ;
Cai, Jennifer X. ;
Schweitzer, Michael A. .
CURRENT OPINION IN GASTROENTEROLOGY, 2015, 31 (05) :359-367