Endoscopic management of perforations, leaks and fistulas

Singh, Ritu; Nussbaum, Jeremy; Kumta, Nikhil A.

doi:10.21037/tgh.2018.10.09

Cited by 40 publications

(52 citation statements)

References 107 publications

(117 reference statements)

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“…Although the treatment of our patient was successful and the chosen technique appropriate, other options with different profiles in terms of safety, cost, and evidence are available; namely, but not limited to, endo-sponge application, placement of a covered self-expanding metal stent, over-the-scope clip (OTSC) positioning, and fibrin glue injection [17]. OTSC has a limited role in large perforations.…”

Section: Discussionmentioning

confidence: 99%

The Usefulness of an Endoscopic OverStitch Suturing System for Managing Anastomotic Dehiscence – A Case Report

Patil

Iyer

Dalal

et al. 2020

GE Port J Gastroenterol

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Anastomotic dehiscence (AD) after colorectal surgery contributes to poor outcomes resulting in multiple postoperative complications. Conventional management would be a repeat laparotomy and tension suturing. But owing to the unhealthy vicinities near the suture lines, there is a significant risk of technical failure which further increases postoperative morbidity and mortality. A 60-year-old male, with a history of hypertension, ischemic heart disease, and previous percutaneous transluminal coronary angioplasty, underwent sigmoid colectomy with colorectal anastomosis for complicated sigmoid diverticulitis. He then developed anastomotic site leak for which an ileostomy was done. Prior to the ileostomy revision, he was referred for colonoscopic evaluation which showed the persistence of a partial AD. We decided to close the defect endoscopically with the Apollo OverStitch device. Initial tissue preparation was done by creating a surgical surface using argon plasma coagulation at the perimeter of the leak site. A double channel therapeutic endoscope with the OverStitch assembly was passed to take full-thickness running sutures across the rent to facilitate full closure. The area examined showed good suture approximation and complete closure. The procedure was successful with no immediate or delayed postprocedural complications. Repeat endoscopic evaluation at about two weeks showed well-approximated edges with intact suture lines, and there was complete resolution of the leak. The patient subsequently underwent revision surgery after a month. The patient is under close follow-up and doing well. The Apollo OverStitch device has certainly opened new avenues in flexible endoscopic surgery which need further exploratory studies to add to existing promising results.

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Section: Discussionmentioning

confidence: 99%

The Usefulness of an Endoscopic OverStitch Suturing System for Managing Anastomotic Dehiscence – A Case Report

Patil

Iyer

Dalal

et al. 2020

GE Port J Gastroenterol

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“…Those stents are the most used in upper gastrointestinal defects, being a successful treatment on perforations and fistulas on esophagus in more of 90% of the cases. 8 This alternative treatment was chosen because of the inaccessibility of the abdomen. Nevertheless, it must be kept in mind all the consequences that a procedure can carry.…”

Section: Discussionmentioning

confidence: 99%

Enterocutaneous fistulas due to stent migration. How reliable is its use on duodenal benign pathology? a case report

Herevia¹,

Hinojosa²,

Ugarte³

et al. 2020

Int J Res Med Sci

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Duodenal stenting has been widely used on malignant pathology on selected patients with poor prognosis and advanced disease. In these last years, there has been a clear ampliation of the clinical applications of endoscopy procedures and stents. Its use on benign pathology is spreading but there is a lack of literature about the complications in this context. The incidence of stent migration is about 10-25% in self-expandable metal stent (SEMS), and 2-5% on covered self-expanding metal stents (CSEMS). We reported a clinical case of a 48 years old patient who developed a duodenal ulcer. The patient was submitted to exploratory laparotomy, with duodenal primary closure of the ulcer. Later, the patient developed a enterocutaneous fistula because of the duodenal leak. It was referred to our third level hospital to the hepatopancreatobiliary surgery service. A new exploratory laparotomy with duodenal exclusion was planned, but it was impossible to access due to frozen abdomen. CSEMS was placed in the duodenal bulb resulting in the resolution of leaking, but the stent could not be removed because of migration. The stent trajectory was followed by abdominal x ray and tomography. The patient developed multiple intestinal an fecal enterocutaneous fistulas. It was submitted to multiples endoscopies, colonoscopies and enteroscopy without any success to reaching it. It was decided to perform a right lumbotomy to extract the prothesis. The stent was surgically removed, a planned stoma was left on the right flank on the extraction site.

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“…18 With early recognition, small perforations can be successfully treated with various endoscopic methods. 19 Two premixed injection solutions are currently approved by the U.S. Food and Drug Administration. The…”

Section: Agents For Submucosal Injectionmentioning

confidence: 99%