Endoscopic Management of Gastrointestinal Complications

2018 ◽  
Vol 02 (04) ◽  
pp. 346-358 ◽  
Author(s):  
Samantha Witte ◽  
Eric Pauli
Keyword(s):  
Enhanced Recovery ◽  
Anastomotic Stricture ◽  
Intestinal Resection ◽  
Therapeutic Endoscopy ◽  
Endoscopic Management ◽  
Management Options ◽  
Gastrointestinal Complications ◽  
Management Of Complications ◽  
Recovery Protocols ◽  
Patient Optimization

AbstractDespite improvements in preoperative patient optimization, refinements in surgical methodology and technology, and the implementation of enhanced recovery protocols, complications following gastrointestinal (GI) surgery remain a fact of life. As the rates of GI surgical procedures increase worldwide, so will the volume of complications. The surgical management of complications is often not ideal, as some (such as acute staple line bleeding or the development of an anastomotic stricture) are luminal-based processes that are difficult to approach from an extraluminal (i.e., surgical) perspective. Endoscopy has largely replaced surgery for the management of such postoperative problems. Leak, the most feared complications of GI surgery, can result from intestinal resection, anastomosis formation, or from iatrogenic injury. With advancements in both diagnostic and therapeutic endoscopy, novel endoluminal and transluminal management options for leak continue to evolve. In centers where these interventions are readily available, they are becoming a first-line treatment option. This article will review the endoscopic management of GI complications with a particular focus on the management of postoperative strictures and of full-thickness GI tract defects (perforations, acute leaks, and chronic fistulae).

Endoscopic Management of Postbariatric Fistulae and Leaks

2015 ◽  
Author(s):  
Yana Cavanagh ◽  
Sohail N. Shaikh
Keyword(s):  
Bariatric Surgery ◽  
Diagnostic Algorithm ◽  
Therapeutic Endoscopy ◽  
Late Complications ◽  
Endoscopic Management ◽  
High Morbidity ◽  
Management Options ◽  
Radiographic Findings ◽  
Computed Tomographic ◽  
American Society

The number of bariatric procedures performed annually is increasing along with the number of complications. Gastrointestinal leak after bariatric surgery generally portends high morbidity and mortality, and its management depends on clinical and radiographic presentation. A leak is defined as an enteric defect with extravasation of luminal contents. Fistulae are abnormal connections between two epithelialized surfaces, are usually chronic, and may develop from long-standing leaks. Endoscopic therapies may offer an attenuated risk profile compared with surgical intervention and play a growing role in the management of postbariatric complications. Leak resolution may require multiple endoscopic sessions and modalities (e.g., stents, adhesives, plugs, clips, suturing, and VAC-assisted closure); therefore, it is critical to have appropriate follow-up and surveillance after therapeutic endoscopic intervention. This review discusses endoscopic leak and fistula management through endoscopic procedures, addressing indications and candidates for procedure, contraindications, recipient evaluation, and aspects of procedure, including proper timing, equipment, and types. Figures show Roux-en-Y gastric bypass, sleeve gastrectomy, management options for leaks after bariatric surgery, a diagnostic algorithm for leaks, upper gastrointestinal series performed with Gastrografin, and computed tomographic scans that demonstrate extraluminal air extending along the diaphragmatic surface of the spleen and a perisplenic gas and fluid-filled collection on the lateral margin. Tables list complications that follow bariatric surgery; an excerpt from the 2008 American Society for Gastrointestinal Endoscopy Guidelines; recommended equipment for endoscopic defect management; classification system based on duration after bariatric surgery; classification and approach to management based on clinical presentation and radiographic findings; summary of recommendations for pre-endoscopy, index endoscopy, therapeutic endoscopy, and posttherapeutic endoscopy; and early and late complications of stent placement. This review contains 7 highly rendered figures, 7 tables, and 104 references.

Endoscopic Management of Postbariatric Fistulae and Leaks

2018 ◽  
Author(s):  
Yana Cavanagh ◽  
Sohail N. Shaikh
Keyword(s):  
Bariatric Surgery ◽  
Diagnostic Algorithm ◽  
Therapeutic Endoscopy ◽  
Late Complications ◽  
Endoscopic Management ◽  
High Morbidity ◽  
Management Options ◽  
Radiographic Findings ◽  
Computed Tomographic ◽  
American Society

The number of bariatric procedures performed annually is increasing along with the number of complications. Gastrointestinal leak after bariatric surgery generally portends high morbidity and mortality, and its management depends on clinical and radiographic presentation. A leak is defined as an enteric defect with extravasation of luminal contents. Fistulae are abnormal connections between two epithelialized surfaces, are usually chronic, and may develop from long-standing leaks. Endoscopic therapies may offer an attenuated risk profile compared with surgical intervention and play a growing role in the management of postbariatric complications. Leak resolution may require multiple endoscopic sessions and modalities (e.g., stents, adhesives, plugs, clips, suturing, and VAC-assisted closure); therefore, it is critical to have appropriate follow-up and surveillance after therapeutic endoscopic intervention. This review discusses endoscopic leak and fistula management through endoscopic procedures, addressing indications and candidates for procedure, contraindications, recipient evaluation, and aspects of procedure, including proper timing, equipment, and types. Figures show Roux-en-Y gastric bypass, sleeve gastrectomy, management options for leaks after bariatric surgery, a diagnostic algorithm for leaks, upper gastrointestinal series performed with Gastrografin, and computed tomographic scans that demonstrate extraluminal air extending along the diaphragmatic surface of the spleen and a perisplenic gas and fluid-filled collection on the lateral margin. Tables list complications that follow bariatric surgery; an excerpt from the 2008 American Society for Gastrointestinal Endoscopy Guidelines; recommended equipment for endoscopic defect management; classification system based on duration after bariatric surgery; classification and approach to management based on clinical presentation and radiographic findings; summary of recommendations for pre-endoscopy, index endoscopy, therapeutic endoscopy, and posttherapeutic endoscopy; and early and late complications of stent placement. This review contains 7 highly rendered figures, 7 tables, and 104 references.

Elderly Patients Benefit From Enhanced Recovery Protocols After Colorectal Surgery

2021 ◽  
Vol 266 ◽  
pp. 54-61
Author(s):  
Jessica Y Liu ◽  
Sebastian D Perez ◽  
Glen G Balch ◽  
Patrick S Sullivan ◽  
Jahnavi K Srinivasan ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Enhanced Recovery ◽  
Recovery Protocols

scholarly journals Markers of Perioperative Bowel Complications in Colorectal Surgery Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Radomír Hyšpler ◽  
Alena Tichá ◽  
Milan Kaška ◽  
Lenka Žaloudková ◽  
Lenka Plíšková ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Intestinal Resection ◽  
Specific Marker ◽  
Exhaled Breath ◽  
Fatty Acid Binding ◽  
Gastrointestinal Complications ◽  
Reactive Protein ◽  
The Difference ◽  
Low Sensitivity

Colorectal cancer is a clinical condition whose treatment often involves intestinal resection. Such treatment frequently results in two major gastrointestinal complications after surgery: anastomotic leakage and prolonged ileus. Anastomotic leakage is a serious complication which, more often than not, is diagnosed late; to date, C-reactive protein is the only available diagnostic marker. A monocentric, prospective, open case-control study was performed in patients(n=117)undergoing colorectal surgery. Intestinal fatty acid binding protein (i-FABP), citrulline, D-lactate, exhaled hydrogen,Escherichia coligenomic DNA, and ischemia modified albumin (IMA) were determined preoperatively, postoperatively, and on the following four consecutive days. Bacterial DNA was not detected in any sample, and i-FABP and D-lactate lacked any distinct potential to detect postoperative bowel complications. Exhaled breath hydrogen content showed unacceptably low sensitivity. However, citrulline turned out to be a specific marker for prolonged ileus on postoperative days 3-4. Using a cut-off value of 20 μmol/L, a sensitivity and specificity of ~75% was achieved on postoperative day 4. IMA was found to be an efficient predictor of anastomosis leak by calculating the difference between preoperative and postoperative values. This test had 100% sensitivity and 80% specificity and 100% negative and 20% positive predictive value.

Endoscopic Management of Complications

2018 ◽  
pp. 269-277
Author(s):  
Manoel Galvao Neto ◽  
Lyz Bezerra Silva ◽  
Luiz Gustavo de Quadros ◽  
Josemberg Campos
Keyword(s):  
Endoscopic Management ◽  
Management Of Complications
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