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DOI: 10.1055/a-1336-2922
Endoscopic ‘suction room’ to treat complex enteral stump leaks after upper gastrointestinal surgery
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Abstract
Leaks/dehiscence of the enteral stump associated with infected peri-enteric collections after upper gastrointestinal surgery are a life-threatening adverse event, not usually endoscopically treatable.
We describe a new endoscopic approach to treat complex entero-cutaneous fistulas (CECF) by creating a “suction room” through placement of multiple stents (enteral, biliary and/or pancreatic) and a large nose-enteral suction tube inside the enteral stent maintained on a continuous negative aspiration suction.
Between January 2016 and December 2019, six consecutive patients referred to our unit with CECF of the enteral stump after failed redo surgeries underwent creation of a “suction room.” In five patients, enteral, biliary and pancreatic stents were positioned before a nose-to-stent or nose-to-collection large 18 Fr tube placement. In one patient, a pancreatic stent was not placed. Technical and clinical success were achieved in all patients. Mean and median times of aspiration were 49 and 27 days, respectively, with a mean hospital stay of 56 days after the endoscopic procedure. Stents were successfully removed. Mean post-procedural follow-up was 17.3 months.
Endoscopic creation of the “suction room” offers the unique possibility of treating complex entero-cutaneous fistulas in surgically altered sites, which are difficult to manage with standard endoscopic methods.
Publication History
Received: 13 August 2020
Accepted: 11 November 2020
Article published online:
19 February 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Loske G. Endoscopic negative pressure therapy of the upper gastrointestinal tract. Chirurg 2019; 90: 1-6
- 2 Babu B, Finch J. Current status in the multidisciplinary management of duodenal fistula. Surgeon 2013; 11: 158-164
- 3 Cozzaglio L, Coladonato M, Biffi R. et al. Duodenal fistula after elective gastrectomy for malignant disease: an Italian retrospective multicenter study. J Gastrointest Surg 2010; 14: 805-811
- 4 Mutignani M, Dioscoridi L, Dokas S. et al. Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: a novel effective rescue procedure. World J Gastrointest Endosc 2016; 8: 533-540
- 5 Wahl P, Lammer F, Conen D. et al. Septic complications after injection of N-butyl-2-cyanoacrylate: report of two cases and review. Gastrointest Endosc 2004; 59: 911-916
- 6 Mutignani M, Forti E, Larghi A. et al. Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complications of hepaticojejunostomy. Endoscopy 2019; 51: 1146-1150
- 7 Mutignani M, Forti E, Pugliese F. et al. New endoscopic technique for uncontrollable bilious vomiting after gastrojejunal surgical bypass. Endoscopy 2017; 49: E225-E226
- 8 Newton NJ, Sharrock A, Rickard R. et al. Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations. Dis Esophagus 2017; 30: 1-5
- 9 Watkins JR, Farivar AS. Endoluminal therapies for esophageal perforations and leaks. Thorac Surg Clin 2018; 28: 541-554