Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature

Verlaan, Tessa; Voermans, Rogier P.; Henegouwen, Mark I. van Berge; Bemelman, Willem A.; Fockens, Paul

doi:10.1016/j.gie.2015.03.1977

Cited by 94 publications

(79 citation statements)

References 53 publications

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“…Verlaan et al performed a large metaanalysis on various endoscopic closure systems. They authors reported successful closure with endoclips (90.2%) and over-the-scope clips (87.8%) but also concluded that there remains many limitations in current literature including the lack of randomized control trials and low methodological quality of studies (45). Wound vacuum therapy has also been investigated and shows promise, especially in patients with an esophageal fistula (46).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents.Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse J Thorac Dis 2017;9(Suppl 2):S135-S145 jtd.amegroups.com significantly less esophageal dilatation, a lower rate of migration and improved palliation for malignant esophageal strictures and malignant tracheo-esophageal fistulae (10,11). However, placement of these prostheses continued to be reserved only for the patient requiring palliative therapy for a malignancy because of the potential esophageal damage associated with extraction including reports of irreparable, sometimes life threatening, fistulae.To combat these complications, second generation metallic stent designs were developed incorporating a covering of silicone, polyurethane or other polymers (12). While offering the advantage of diminishing amount of tumor ingrowth and fixation to the esophageal wall, it came with the cost of higher migration rates. Later, the ends of these covered stents were modified to be partially covered with a margin of 1.5 cm on both proximal and distal ends to optimize purchase of the esophageal wall (13).Further evolution in esophageal stent biomaterials resulted in the development of an occlusive plastic prosthesis coated with silicone. This new design allowed ease of insertion, a minimal requirement for esophageal dilation and the ability to form an occlusive seal within the lumen of the esophagus (14). The distinctive advantage of these non-metallic endoprostheses was the ability for removal or replacement even after an extended period of time without damage to the esophagus. However, similar to the covered metallic stents, a higher incidence of migration was appreciated (15).These synergistic developments led to a crucial turning point in management of esophageal perforations. The ease in manipulation of high-quality covered, occlusive stents in the esophagus, led some investigators to implant these stents in select patients as a temporary measure to treat intrathoracic anastomotic leaks following esophagogastrostomy and acute perforations. Segalin et al. and Roy-Choudhury et al. were am...

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Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal leaks

Ong¹,

Freeman²

2017

J. Thorac. Dis.

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“…As recently described in review by Verlaan et al, endoscopic repair with TTS has an overall success rate of 90.2% for perforations at various locations. [15] Despite OTS has showed a technical success rate of 97.1%, its clinical success has been described much lower (70%) in recently published retrospective multicenter studies. [16] SEMS represent an effective alternative to endoclip therapy in case of EP with observed technical and clinical success rates of 91% and 81%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of esophageal perforation caused by calibrating bougie during laparoscopic sleeve gastrectomy

Martines

Digennaro

Fazio

et al. 2017

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Background: Laparoscopic Sleeve Gastrectomy (LSG) is one of the most used surgical techniques for the treatment of morbid obesity. The esophageal perforation (EP) secondary to the use of calibrating bougie is a rare complication. Case presentation: A 43-year-old woman with a body mass index (BMI) of 54 kg/m 2 underwent LSG. During the use of a calibrating bougie, a distal EP occurred, but it became evident only during the second day after the surgery. The patient was hospitalized in Intensive Care Unit because of respiratory failure and her clinical conditions did not permit a safe surgical treatment. The EP was treated successfully by endoscopic conservative approach with a double-covered self-expanding endoprosthesis (SEMS).Results: The esophageal calibrating bougie, often placed by an anaesthesiologist, is undoubtedly useful during the learning curve of the surgeon to ensure a correct sleeve size; however, it may result in severe and difficult-to-treat iatrogenic lesions. Conclusions: Managing the complications through conservative endoscopy is possible, but in order to support these patients, the immediate availability of an intensive care unit is essential. We underline the importance of a dedicated team of surgeons and anaesthesiologists and a multidisciplinary team to treat major complications in bariatric surgery.

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“…7), over-the-scope clips, band ligation and endoloops. 172,[187][188][189] Novel endoscopic suturing devices may be applied in this scenario to close large defects. Although the technical application of endoscopic suturing may be challenging and not readily available in most units, the potential to close large defects with multiple sutures through the endoscope is attractive.…”

Section: Managementmentioning

confidence: 99%

“…190,191 The rates of successful endoscopic closure for small duodenal perforations (< 13 mm) with clips range from 88%-100%. 188,192 In patients that do undergo successful endoscopic closure, the chance of clinical successful recovery without surgery is > 90%. 172 Conservative management after endoscopic closure includes IVF, bowel rest, antibiotics and NGT placement.…”

Section: Managementmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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Endoscopic closure of acute perforations of the GI tract: a systematic review of the literature

Cited by 94 publications

References 53 publications

Endoscopic management of esophageal leaks

Endoscopic management of esophageal leaks

Endoscopic management of esophageal perforation caused by calibrating bougie during laparoscopic sleeve gastrectomy

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

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