Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks

Rodrigues‐Pinto, Eduardo; Pereira, Pedro; Sousa‐Pinto, Bernardo; Shehab, Hany; Pinho, Rolando; Larsen, Michael; Irani, Shayan; Kozarek, Richard A.; Capogreco, Antonio; Repici, Alessandro; Shemmeri, Ealaf; Louie, Brian E.; Rogalski, Paweł; Baniukiewicz, Andrzej; Dâbrowski, A; Sousa, João Correia de; Barrias, Sílvia; Ichkhanian, Yervant; Kumbhari, Vivek; Khashab, Mouen A.; Bowers, Nicole; Schulman, Allison R.; Macedo, Guilherme

doi:10.1016/j.gie.2020.10.015

Cited by 17 publications

(20 citation statements)

References 33 publications

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“…Even though the clinical success rates are comparable, SEMSs are reported to perform better than SEPSs in leaks and perforations, with higher technical success (95 % vs. 91 %; P = 0.03), and reduced risk of migration (16 % vs. 24 %; P = 0.001) and stent repositioning (3 % vs. 11 %; P < 0.001), as well as a reduced risk of perforation when considering anastomotic leaks only (0 % vs. 2 %; P = 0.01) [116]. Data on the use of BDSs in these patients are restricted to a few small retrospective studies (Table 5s) [117][118][119].…”

Section: Leaks Fistulas and Perforationsmentioning

confidence: 99%

“…The use of endoscopic vacuum therapy was associated with a higher leak closure rate, more endoscopic device changes, shorter duration of treatment, and lower in-hospital mortality. Because the management of these patients may be challenging and often requires a multimodality approach, esophageal stent placement may still be considered in addition to other endoscopic techniques to optimize treatment outcomes [119].…”

Section: Leaks Fistulas and Perforationsmentioning

confidence: 99%

“…Stent migration is the most common stent-related adverse event and tends to be higher when FCSEMSs (26 %) and SEPSs are used (31 %) compared with PCSEMSs (12 %) [114]. The use of large-diameter SEMSs has been suggested to reduce the risk of stent migration in anastomotic leaks [119]. Furthermore, suturing of FCSEMSs may render migration rates similar to those of PCSEMSs, without the difficulties associated with the removal of PCSEMSs and with a lower risk of adverse events [125].…”

Section: Safetymentioning

confidence: 99%

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Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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Section: Leaks Fistulas and Perforationsmentioning

confidence: 99%

Section: Leaks Fistulas and Perforationsmentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

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Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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“…1 In patients who undergo rescue or redo surgery, the mortality increases to 15% to 30% and recurrence in up to one third of patients. 1 In this issue of Gastrointestinal Endoscopy, Rodrigues-Pinto et al 2 present the results from a retrospective multicenter international study on endoscopic treatment of upper GI postsurgical leaks.…”

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confidence: 99%

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

Buttar

2021

Gastrointestinal Endoscopy

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“…1 Early diagnosis has been reported to improve survival in patients with such leaks, 2,3 although management still remains controversial. 3,4 Several modalities have been used in managing postsurgical leaks, with surgical treatment being associated with higher morbidity and mortality than endoscopic therapy. Often, more than 1 endoscopic approach is used concomitantly, whereas in other cases, therapies are applied sequentially depending on clinical response.…”

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confidence: 99%

Stent deployment within a transesophagostomy orifice to treat a postgastrectomy leak

et al. 2021

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Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks

Cited by 17 publications

References 33 publications

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Minimally invasive endoscopic approaches to manage postsurgical leaks: time to recognize the finger in the dike

Stent deployment within a transesophagostomy orifice to treat a postgastrectomy leak

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