Digestive leaks: An approach tailored to both indication and anatomy

Eisendrath, Pierre; Devière, Jacques

doi:10.1055/s-0042-105865

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Proper selection of patients is critical for favourable outcomes, and the approach to UGI PSL should always be tailored to the single patient. So, it requires a personalized and multidisciplinary approach, comprising a close collaboration between interventional endoscopist, radiologist, and surgeon, allowing PSL management with high clinical success rate and low rate of morbidity and mortality [ 111 , 112 ].…”

Section: Discussionmentioning

confidence: 99%

Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks

Medas

Rodrigues‐Pinto

2023

Gastroenterology Research and Practice

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Upper gastrointestinal postsurgical leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Nowadays, endoscopy is considered the first-line approach for their management, however, there is no definite consensus on the most appropriate therapeutic approach. There is a wide diversity of endoscopic options, from close-cover-divert approaches to active or passive internal drainage approaches. Theoretically, all these options can be used alone or with a multimodality approach, as each of them has different mechanisms of action. The approach to postsurgical leaks should always be tailored to each patient, taking into account the several variables that may influence the final outcome. In this review, we discuss the important developments in endoscopic devices for the treatment of postsurgical leaks. Our discussion specifically focuses on principles and mechanism of action, advantages and disadvantages of each technique, indications, clinical success, and adverse events. An algorithm for endoscopic approach is proposed.

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Section: Discussionmentioning

confidence: 99%

Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks

Medas

Rodrigues‐Pinto

2023

Gastroenterology Research and Practice

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“…Over the last 30 years, therapeutic endoscopy has earned a pivotal role in the management of anastomotic leaks as well as the management of fistulas, mainly occurring in oncological patients, the technological advancements having established it as a first line approach over surgery and not only as a rescue treatment [98][99][100].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Salvage of Gastrointestinal Anastomosis Leaks—Past, Present, and Future—A Narrated Review

Menni,

Stavrou,

Tzikos

et al. 2023

Gastrointestinal Disorders

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Background: Anastomotic leakage, which is defined as a defect in the integrity of a surgical join between two hollow viscera leading to communication between the intraluminal and extraluminal compartments, continues to be of high incidence and one of the most feared complications following gastrointestinal surgery, with a significant potential for a fatal outcome. Surgical options for management are limited and carry a high risk of morbidity and mortality; thus, surgeons are urged to look for alternative options which are minimally invasive, repeatable, non-operative, and do not require general anesthesia. Methods: A narrative review of the international literature took place, including PubMed, Scopus, and Google Scholar, utilizing specific search terms such as “Digestive Surgery AND Anastomotic Leakage OR leak OR dehiscence”. Results: In the present review, we try to describe and analyze the pros and cons of the various endoscopic techniques: from the very first (and still available), fibrin gluing, to endoclip and over-the-scope clip positioning, stent insertion, and the latest suturing and endoluminal vacuum devices. Finally, alongside efforts to improve the existing techniques, we consider stem cell application as well as non-endoscopic, and even endoscopic, attempts at intraluminal microbiome modification, which should ultimately intervene pre-emptively, rather than therapeutically, to prevent leaks. Conclusions: In the last three decades, this search for an ideal device for closure, which must be safe, easy to deploy, inexpensive, robust, effect rapid and stable closure of even large defects, and have a low complication rate, has led to the proposal and application of a number of different endoscopic devices and techniques. However, to date, there is no consensus as to the best. The literature contains reports of only small studies and no randomized trials, failing to take into account both the heterogeneity of leaks and their different anatomical sites.

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“…Therapeutic endoscopy plays a major role in management of UGI anastomotic leaks, offering an effective treatment alternative to repeat surgery 10 . The available endoscopic approaches range from primary to secondary closure techniques, with varying degrees of technical and clinical success and adverse events, generating a lack of consensus regarding the most appropriate endoscopic management 11 .…”

Section: Discussionmentioning

confidence: 99%

International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks

Rodrigues‐Pinto

Repici

Donatelli³

et al. 2019

Endosc Int Open

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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.

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Digestive leaks: An approach tailored to both indication and anatomy

Cited by 6 publications

References 8 publications

Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks

Technical Review on Endoscopic Treatment Devices for Management of Upper Gastrointestinal Postsurgical Leaks

Endoscopic Salvage of Gastrointestinal Anastomosis Leaks—Past, Present, and Future—A Narrated Review

International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks

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