scholarly journals Endoscopic Internal Drainage with Double Pigtail Stents for Upper Gastrointestinal Anastomotic Leaks: Suitable for All Cases?

2022 ◽  
Author(s):  
Bin Chet Toh ◽  
Jingli Chong ◽  
Baldwin PM Yeung ◽  
Chin Hong Lim ◽  
Eugene KW Lim ◽  
...  
2019 ◽  
Vol 07 (12) ◽  
pp. E1671-E1682 ◽  
Author(s):  
Eduardo Rodrigues-Pinto ◽  
Alessandro Repici ◽  
Gianfranco Donatelli ◽  
Guilherme Macedo ◽  
Jacques Devière ◽  
...  

Abstract Background and study aims A variety of endoscopic techniques are currently available for treatment of upper gastrointestinal (UGI) anastomotic leaks; however, no definite consensus exists on the most appropriate therapeutic approach. Our aim was to explore current management of UGI anastomotic leaks. Methods A survey questionnaire was distributed among international expert therapeutic endoscopists regarding management of UGI anastomotic leaks. Results A total of 44 % of 163 surveys were returned; 69 % were from gastroenterologists and 56 % had > 10 years of experience. A third of respondents treat between 10 and 19 patients annually. Fifty-six percent use fully-covered self-expandable metal stents as their usual first option; 80% use techniques to minimize migration; 4 weeks was the most common reported stent dwell time. Sixty percent perform epithelial ablation prior to over-the-scope-clip placement or suturing. Regarding endoscopic vacuum therapy (EVT), 56 % perform balloon dilation and intracavitary EVT in patients with large cavities but small leak defects. Regarding endoscopic septotomy, 56 % consider a minimal interval of 4 weeks from surgery and 90 % consider the need to perform further sessions. Regarding endoscopic internal drainage (EID), placement of two stents and shorter stents is preferred. Persistent inflammation with clinical sepsis was the definition most commonly reported for endoscopic failure. EVT/stent placement and EVT/EID were the therapeutic options most often chosen in patients with previous oncologic surgery and previous bariatric surgery, respectively. Conclusions There is a wide variation in the management of patients with UGI anastomotic leaks. Future prospective studies are needed to move from an expert- to evidence- and personalization-based care.


Author(s):  
Esteban Fuentes-Valenzuela ◽  
Francisco Javier García-Alonso ◽  
Javier Tejedor-Tejada ◽  
Rodrigo Najera-Muñoz ◽  
Marina De Benito Sanz ◽  
...  

Endoscopy ◽  
2021 ◽  
Author(s):  
Carlo Jung ◽  
Rachel Hallit ◽  
Annegret Müller-Dornieden ◽  
Melanie Calmels ◽  
Diane Goere ◽  
...  

Background: Endoscopic internal drainage (EID) with double pigtail stents and low negative pressure endoscopic vacuum therapy (EVT) are treatment options for leakages after upper GI oncologic surgery. We aimed to compare the effectiveness of these techniques. Patients and methods: Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtails were changed every 4 weeks, EVT was repeated every 3-4 days until leak closure. Results: 35 EID and 27 EVT patients were included, with a median leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100% [CI 90; 100] in EID vs. 85.2% [CI 66.3; 95.8] in EVT, p=0.03. The median number of endoscopic procedures was 2 (2; 3) vs. 3 (2; 6.5), p<0.01 and the median treatment duration was 42 (28; 60) vs. 17 days (7.5; 28), p<0.01, for EID vs. EVT, respectively. Conclusion: EID and EVT provide high closure rates for upper GI anastomotic leakages. EVT provides a shorter treatment duration at the cost of a higher number of procedures.


2021 ◽  
Vol 267 ◽  
pp. 516-526
Author(s):  
Lukas F. Liesenfeld ◽  
Thomas Schmidt ◽  
Christine Zhang-Hagenlocher ◽  
Peter Sauer ◽  
Markus K. Diener ◽  
...  

Author(s):  
Diane Lorenzo ◽  
Laura Bromberg ◽  
Marianna Arvanitakis ◽  
Myriam Delhaye ◽  
Michael Fernandez Y. Viesca ◽  
...  

2021 ◽  
Author(s):  
Alessandra D’Alessandro ◽  
Giovanni Galasso ◽  
Francesco Paolo Zito ◽  
Cristiano Giardiello ◽  
Fabrizio Cereatti ◽  
...  

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