Endoscopic Clipping of Anastomotic Leakages in Esophagogastric Surgery

Abstract

Endoscopic treatment of anastomotic leakages by metallic clips represents a safe and easily repeated method and, compared to conservative treatment, it seems to offer several time and cost advantages. Further studies involving a larger number of patients are needed to verify this finding.

Endoscopic management of postoperative fistulas and leaks

“…10 Other limitations of TTSC include smaller width of the clips arms (10-12 mm when completely opened) and limited tissue pressure from the clip which necessitates multiple clips to cover smaller defects there by increasing the cost of the procedure. 11,12 These limitations could be overcome by using OTSC (Ovesco Endoscopy AG, Tübingen, Germany) which is a Nitinol clip that comes loaded over a transparent cap that can be fitted to the tip of the scope and deployed from the cap after the tissue surrounding the defect is suctioned into the cap. 13 It can be used for full thickness defects and has high compression force on tissue.…”

Endoscopic Clipping and Application of Fibrin Glue for an Esophago-Mediastinal Fistula

“…Application of an endoclip is a relatively simple procedure and recently reported as a method for closing anastomotic leakage of gastrointestinal tract [10,[23][24][25][26][27][28] (Table.1.). The clip fixing device with a loaded clip can be passed through the forceps channel of a standard endoscope.…”

“…A combination of clipping and fibrin sealing is probably more effective, especially in treatment of larger leakages [10,28,29]. H. Messmann et al applied several careful injections into the tissue using a double-lumen needle between the placed clips and also mentioned that their own experience with clips alone is not as positive as it is mentioned.…”

“…Rodella reported that endoscopic clipping to close an anastomotic leakage after a gastrectomy was effective and required only a short hospital day [10]. There are hardly any reports of endoscopic clipping for anastomotic leakage after an esophagectomy, although this technique has been performed on rare occasions for anastomotic leakage of duodenal stump or colorectal surgery.…”

Self expandable metallic stent for the treatment of post-operative esophagojejuno anastomotic leak

“…4 Surgical repair of esophageal leaks involve a risky intervention with important consumption of hospital resources and prolonged in-hospital stay. Endoscopic techniques such as clipping 5 or fibrin glue application 5 have been proposed as alternatives, but with poor results, particularly in cases of extensive dehiscence.…”