Endoscopy 2020; 52(S 01): S35
DOI: 10.1055/s-0040-1704113
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 Advances in endoluminal endoscopy Liffey Meeting Room 2
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MANAGEMENT OF POST-OPERATIVE ANASTOMOTIC LEAKAGE OR FISTULA AFTER ESOPHAGOGASTRIC RESECTION FOR MALIGNANCY: A FRENCH MULTICENTER EXPERIENCE

R Hallit
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
,
M Calmels
2   St Louis University Hospital, Assistance Publique Hôpitaux de Paris and University of Paris, Digestive Surgery Department, Paris, France
,
U Chaput
3   St Antoine University Hospital, Assistance Publique Hôpitaux de Paris and Sorbonne Paris Cité University, Gastroenterology Department, Paris, France
,
D Lorenzo
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
,
A Becq
3   St Antoine University Hospital, Assistance Publique Hôpitaux de Paris and Sorbonne Paris Cité University, Gastroenterology Department, Paris, France
,
M Camus
3   St Antoine University Hospital, Assistance Publique Hôpitaux de Paris and Sorbonne Paris Cité University, Gastroenterology Department, Paris, France
,
X Dray
3   St Antoine University Hospital, Assistance Publique Hôpitaux de Paris and Sorbonne Paris Cité University, Gastroenterology Department, Paris, France
,
JM Gonzalez
4   North Hospital, Assistance Publique - Hôpitaux de Marseille and University of Aix-Marseille, Gastroenterology Department, Marseille, France
,
M Barthet
4   North Hospital, Assistance Publique - Hôpitaux de Marseille and University of Aix-Marseille, Gastroenterology Department, Marseille, France
,
J Jacques
5   Limoges University Hospital, and University Limoges, Gastroenterology Department, Limoges, France
,
R Legros
5   Limoges University Hospital, and University Limoges, Gastroenterology Department, Limoges, France
,
P Cattan
2   St Louis University Hospital, Assistance Publique Hôpitaux de Paris and University of Paris, Digestive Surgery Department, Paris, France
,
A Belle
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
,
S Chaussade
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
,
R Coriat
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
,
F Prat
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
,
D Goere
2   St Louis University Hospital, Assistance Publique Hôpitaux de Paris and University of Paris, Digestive Surgery Department, Paris, France
,
M Barret
1   Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Gastroenterology Department, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Esophagectomy remains the standard care for a vast proportion of esophageal or esophagogastric lesions.This procedure is associated in 10% of cases with anastomotic fistulas. Endoscopic management of post-operative anastomotic complications has been mostly reported with esophageal stents.Recently, internal drainage by double pigtail stents has been introduced for managing these complications.Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophagogastric resection for cancer.

    Methods We conducted a multicenter retrospective study in 5 french reference centers for digestive endoscopy including 68 patients operated between January 2016 and December 2018. We included patients with anastomotic leakage following surgical resection of cancers of the esophagus or the esophago-gastric junction. The primary outcome was the efficacy of the endoscopic management on fistula closure. The secondary outcomes were the efficacy of internal drainage with a double pigtail stent or anastomotic coverage with a self-expandable metal stent (SEMS), the number of endoscopic treatment sessions needed, the factors associated with treatment success, and the incidence of anastomotic esophageal strictures.

    Results 68 patients were included, with 46 men and 22 women, and a mean±SD age of 61±11 years. 44% had an Ivor Lewis procedure,16% a tri-incisional esophagectomy, and 40% a total gastrectomy.51% had received neoadjuvant chemotherapy, 12% neoadjuvant chemoradiotherapy, and 37% did not receive any neoadjuvant treatment.Overall endoscopic treatment was effective in 90%(61/68) of the patients. The efficacy of internal drainage and anastomotic coverage were 95% and 79% respectively(p= 0.06). The mortality rate was 3%. In univariate analysis, the only predictor of successful endoscopic treatment was the use of internal drainage(p =0.002).

    Conclusions Endoscopic management of early postoperative leakages is successful in 90% making it possible to avoid highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas complicating esophagogastric cancer resection surgery whenever technically feasible.


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