Endoscopy 2020; 52(S 01): S28
DOI: 10.1055/s-0040-1704088
ESGE Days 2020 oral presentations
Friday, April 24, 2020 17:00 – 18:30 Advances in endoluminal and biliopancreatic endoscopy The Liffey A
© Georg Thieme Verlag KG Stuttgart · New York

RETROSPECTIVE MULTICENTER STUDY ON ENDOSCOPIC TREATMENT OF UPPER GASTROINTESTINAL POST-SURGICAL LEAKS

E Rodrigues-Pinto
1   Centro Hospitalar São João, Gastroenterology, Porto, Portugal
,
P Pereira
1   Centro Hospitalar São João, Gastroenterology, Porto, Portugal
,
R Morais
1   Centro Hospitalar São João, Gastroenterology, Porto, Portugal
,
H Shehab
2   Cairo University Hospital, Gastroenterology, Cairo, Egypt
,
R Pinho
3   Centro Hospitalar Vila Nova de Gaia/Espinho, Gastroenterology, Vila Nova de Gaia, Portugal
,
MC Larsen
4   Virginia Mason Medical Center, Gastroenterology and Hepatology,, Seattle, United States of America
,
S Irani
4   Virginia Mason Medical Center, Gastroenterology and Hepatology,, Seattle, United States of America
,
RA Kozarek
4   Virginia Mason Medical Center, Gastroenterology and Hepatology,, Seattle, United States of America
,
MD Leo
5   Humanitas Research Hospital, Digestive Endoscopy Unit, Milan, Italy,
,
A Repici
5   Humanitas Research Hospital, Digestive Endoscopy Unit, Milan, Italy,
,
E Shemmeri
6   Swedish Cancer Institute, Division of Thoracic Surgery, Seattle, United States of America
,
BE Louie
6   Swedish Cancer Institute, Division of Thoracic Surgery, Seattle, United States of America
,
P Rogalski
7   Medical University of Bialystok, Gastroenterology and Internal Medicine, Bialystok, Poland
,
A Baniukiewicz
7   Medical University of Bialystok, Gastroenterology and Internal Medicine, Bialystok, Poland
,
A Dabrowski
7   Medical University of Bialystok, Gastroenterology and Internal Medicine, Bialystok, Poland
,
JC de Sousa
8   Centro Hospitalar do Porto, Gastroenterology, Porto, Portugal
,
S Barrias
8   Centro Hospitalar do Porto, Gastroenterology, Porto, Portugal
,
Y Ichkhanian
9   Johns Hopkins Hospital, Department of Medicine and Division of Gastroenterology and Hepatology, Baltimore, United States of America
,
V Kumbhari
9   Johns Hopkins Hospital, Department of Medicine and Division of Gastroenterology and Hepatology, Baltimore, United States of America
,
MA Khashab
9   Johns Hopkins Hospital, Department of Medicine and Division of Gastroenterology and Hepatology, Baltimore, United States of America
,
N Bowers
10   University of Michigan, Gastroenterology and Hepatology, Ann Arbor, United States of America
,
AR Schulman
10   University of Michigan, Gastroenterology and Hepatology, Ann Arbor, United States of America
,
G Macedo
1   Centro Hospitalar São João, Gastroenterology, Porto, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Therapeutic endoscopy plays a major role in the management of upper gastrointestinal (UGI) post-surgical leaks, with multiple endoscopic techniques being available. Data is scarce regarding clinical success and safety. Evaluate endoscopic therapy results on the management of UGI post-surgical leaks regarding number and order of therapies performed, as well as safety, clinical success and long-term follow-up

Methods Multicenter, international, retrospective study from 10 centers of consecutive patients who underwent endoscopic treatment of UGI post-surgical leaks.

Results 206 patients (50.5% male) were included. Previous surgery most often performed was sleeve gastrectomy (38.8%), followed by total gastrectomy (21.8%) and Ivor-Lewis esophagectomy (15.0%). Median time from surgery to endoscopic treatment was 16 days. Global leak closure was observed in 187 patients (90.8%). Endoscopic closure was achieved in 165 patients (80.1%), after a median follow-up of 52 days (range 0-693). In 8 patients (3.9%) in whom leak closure was not achieved, a stent was left-in-place, without leak persistence. Fourteen patients (6.8%) underwent surgery after endoscopic treatment failure, with leak closure in 12. One patient underwent radiological leak closure and one patient had spontaneous closure. Multimodal therapeutic endoscopy was necessary in 40.8% of patients (n=84; median number of different therapies: 2; range 1-6). Median number of endoscopic procedures/per patient was 3 (range 1-26). Success-rate of leak closure was 41.3% (85/206) with first endoscopic technique, 44.3% (47/106) with second, 35.6% (16/45) with third, 59.1% (13/22) with fourth technique, 80.0% (4/5) with fifth. Global rate of at least one endoscopic therapy-related adverse event (AE) was 39.3% (n=81; one AE: n=60; two AEs: n=21), being severe in 10 patients (4.9%). Leak-related mortality rate was 11.6% (n=24).

Conclusions Multimodal therapeutic endoscopy, despite time-consuming, allows leak closure in a significant proportion of patients, with a low rate of associated severe-AEs.