Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series

Donatelli, Gianfranco; Dumont, Jean-Loup; Cereatti, Fabrizio; Dhumane, Parag; Tuszynski, Thierry; Vergeau, Bertrand Marie; Meduri, Bruno

doi:10.1055/s-0042-105206

Cited by 37 publications

(26 citation statements)

References 11 publications

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“…They were thus successfully treated with endoscopic dilation[ 67 ]. In a case series of 11 patients, Donatelli et al[ 70 ] proposed EID as first line treatment for fistula following GI surgery different from bariatric procedures. Leaks were as follow: 4 duodenal leaks (biliopancreatic cancer), 2 colonic leaks (colorectal surgery) and 5 esophagogastric-jejunal fistulas (foregut surgery).…”

Section: Endoscopic Internal Drainagementioning

confidence: 99%

Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

Cereatti

Grassia

Drago

et al. 2020

WJG

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Gastrointestinal leaks and fistulae are serious, potentially life threatening conditions that may occur with a wide variety of clinical presentations. Leaks are mostly related to post-operative anastomotic defects and are responsible for an important share of surgical morbidity and mortality. Chronic leaks and long standing post-operative collections may evolve in a fistula between two epithelialized structures. Endoscopy has earned a pivotal role in the management of gastrointestinal defects both as first line and as rescue treatment. Endotherapy is a minimally invasive, effective approach with lower morbidity and mortality compared to revisional surgery. Clips and luminal stents are the pioneer of gastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing system and vacuum therapy, has broadened the indications of endoscopy for the management of GI wall defect. Although several endoscopic options are currently used, a standardized evidence-based algorithm for management of GI defect is not available. Successful management of gastrointestinal leaks and fistulae requires a tailored and multidisciplinary approach based on clinical presentation, defect features (size, location and onset time), local expertise and the availability of devices. In this review, we analyze different endoscopic approaches, which we selected on the basis of the available literature and our own experience. Then, we evaluate the overall efficacy and procedural-specific strengths and weaknesses of each approach.

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Section: Endoscopic Internal Drainagementioning

confidence: 99%

Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

Cereatti

Grassia

Drago

et al. 2020

WJG

Self Cite

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“…The success rate decreases with the interval between the initial surgery and endoscopic treatment. Surgical options to treat a chronic gastric leaks are technically challenging and therefore unsuccessful in many cases [20,41,42].…”

Section: Management Of Gastrointestinal Leaksmentioning

confidence: 99%

“…In cases where conventional endoscopic treatment is not successful, endoscopic vacuum therapy (EVT) and internal drainage with pigtails have been used effectively. EVT is a technique that allows internal drainage, thus controlling the infection and promoting tissue healing [20,41,54,55]. EVT is frequently used for gastroesophageal leaks with clinical success higher than 80%.…”

Section: Management Of Gastrointestinal Leaksmentioning

confidence: 99%

“…Selective catheterization of the leak is performed and a double pigtail stent deployed, providing internal drainage, thus allowing tissue healing and leak and/or cavity closure. In the first series including leaks in various types of surgery, technical success was achieved in 100% of patients with a clinical success 82% [41].…”

Section: Management Of Gastrointestinal Leaksmentioning

confidence: 99%

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Endoscopic Full-Thickness Defects and Closure Techniques

Moura

Sachdev

Thompson

2018

Curr Treat Options Gastro

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Purpose of review: Gastrointestinal transmural defects are defined as total rupture of the gastrointestinal wall and can be divided into three main categories: perforations, leaks and fistulas. Due to an increase in the number of therapeutic endoscopic procedures including full thickness resections and the increase incidence of complications related to bariatric surgeries there has been an increase the number of transmural defects seen in clinical practice and the number of non-invasive endoscopic treatment procedures used to treat these defects. Recent findings: The variety of endoscopic approaches and devices, including closure techniques using clips, endoloop and endoscopic sutures; covering techniques such as the cardiac septal occluder device, luminal stents and tissue sealants; and drainage techniques including endoscopic vacuum therapy, pigtail and septotomy with balloon dilation are transforming endoscopy as the first-line approach for therapy of these conditions. Summary: In this review, we describe the various transmural defects and the endoscopic techniques and devices used in their closure.

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“…It is also useful for those relapsing after initial stent therapy [4]. The patients reported on by Donatelli et al [5] [reference to be modified depending on journal issue] in this issue represent an ideal group for EID, both for anatomical and clinical/timing reasons. Indeed, the majority of their patients have fistulae located in the duodenum or the colon, which are not anatomically adapted for stent therapy, while their patients with esophagojejunal leaks after total gastrectomy had no external drainage, making EID the best first-line approach.…”

mentioning

confidence: 99%