RSS-Feed abonnieren
DOI: 10.1055/s-0040-1704088
RETROSPECTIVE MULTICENTER STUDY ON ENDOSCOPIC TREATMENT OF UPPER GASTROINTESTINAL POST-SURGICAL LEAKS
Publikationsverlauf
Publikationsdatum:
23. April 2020 (online)
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.