Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks

Eduardo Rodrigues-Pinto, Pedro Pereira, Bernardo Sousa-Pinto, Hany Shehab, Rolando Pinho, Michael C. Larsen, Shayan Irani, Richard A. Kozarek, Antonio Capogreco, Alessandro Repici, Ealaf Shemmeri, Brian E. Louie, Pawel Rogalski, Andrzej Baniukiewicz, Andrzej Dabrowski, João Correia de Sousa, Silvia Barrias, Yervant Ichkhanian, Vivek Kumbhari, Mouen A. KhashabNicole Bowers, Allison R. Schulman, Guilherme Macedo

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background and Aims: Therapeutic endoscopy plays a critical role in the management of upper GI (UGI) postsurgical leaks. Data are scarce regarding clinical success and safety. Our aim was to evaluate the effectiveness of endoscopic therapy for UGI postsurgical leaks and associated adverse events (AEs) and to identify factors associated with successful endoscopic therapy and AE occurrence. Methods: This was a retrospective, multicenter, international study of all patients who underwent endoscopic therapy for UGI postsurgical leaks between 2014 and 2019. Results: Two hundred six patients were included. Index surgery most often performed was sleeve gastrectomy (39.3%), followed by gastrectomy (23.8%) and esophagectomy (22.8%). The median time between index surgery and commencement of endoscopic therapy was 16 days. Endoscopic closure was achieved in 80.1% of patients after a median follow-up of 52 days (interquartile range, 33-81.3). Seven hundred seventy-five therapeutic endoscopies were performed. Multimodal therapy was needed in 40.8% of patients. The cumulative success of leak resolution reached a plateau between the third and fourth techniques (approximately 70%-80%); this was achieved after 125 days of endoscopic therapy. Smaller leak initial diameters, hospitalization in a general ward, hemodynamic stability, absence of respiratory failure, previous gastrectomy, fewer numbers of therapeutic endoscopies performed, shorter length of stay, and shorter times to leak closure were associated with better outcomes. Overall, 102 endoscopic therapy–related AEs occurred in 81 patients (39.3%), with most managed conservatively or endoscopically. Leak-related mortality rate was 12.4%. Conclusions: Multimodal therapeutic endoscopy, despite being time-consuming and requiring multiple procedures, allows leak closure in a significant proportion of patients with a low rate of severe AEs.

Original languageEnglish (US)
Pages (from-to)1283-1299.e2
JournalGastrointestinal endoscopy
Volume93
Issue number6
DOIs
StatePublished - Jun 2021

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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