R Manta et al., Niguarda-Ca Granda Hospital, Milan, Nuovo S. Agostino Hospital, Modena, Nuovo Regina Margherita Hospital, Rome, Baggiovara Hospital Modena and Federico II University of Naples, Naples, all Italy, published a large case series on patients with post-surgical gastrointestinal leaks managed with endoscopy as initial approach.
A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract. The first attempt for leak closure was the application of one or more OTSC clips. Fibrin glue was used as an adjuvant treatment to close the gap between two OTSCs where needed. A covered self-expanding metal-stent (SEMS) was applied when the closure was considered incomplete at endoscopy. When dehiscence characteristics were not fitting for OTSC positioning, a SEMS was directly used. Endosponge was the first line therapy, when an abscess cavity was present beyond the anastomotic leak.
Leak closure was successful in 39 patients with upper GI-leaks (83%) and 22 patients with lower GI leaks (75.9%), accounting for an overall 80.3 % success rate. Leak closure failed in 15 (19.7 %) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at day 7 post-op.
The authors conclude that an endoscopic approach is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, endoscopic treatment should be attempted before resorting to more invasive, costly and risky re-interventions.
Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: A large case series
Manta R, Caruso A, Cellini C, Sica M, Zullo A, Mirante VG, Bertani H, Frazzoni M, Mutignani M, Galloro G, Conigliaro R (2015)
United European Gastroenterology Journal 0(0) 1–8 DOI: 10.1177/2050640615626051