Raffaele Manta1, Angelo Caruso2, Carlo Cellini2, Mariano Sica2, Angelo Zullo3, Vincenzo Giorgio Mirante2, Helga Bertani2, Marzio Frazzoni4, Massimiliano Mutignani1, Giuseppe Galloro5, Rita Conigliaro2. 1. Surgical Digestive Diagnostic and Interventional Endoscopy, "Niguarda-Cà Granda" Hospital, Milan, Italy. 2. Gastroenterology and Endoscopy Unit, "Nuovo S. Agostino" Hospital, Modena, Italy. 3. Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, Rome, Italy. 4. Digestive Physiopathology Unit, Baggiovara Hospital, Modena, Italy. 5. Department of Clinical Medicine and Surgery, Unit of Surgical Digestive Endoscopy, Federico II University of Naples, Naples, Italy.
Abstract
BACKGROUND: Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. METHODS: This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient's status. RESULTS: A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. CONCLUSIONS: Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention.
BACKGROUND: Post-surgical anastomotic leaks often require a re-intervention, are associated with a definite morbidity and mortality, and with relevant costs. We described a large series of patients with different post-surgical leaks involving the gastrointestinal tract managed with endoscopy as initial approach. METHODS: This was a retrospective analysis of prospectively collected cases with anastomotic leaks managed with different endoscopic approaches (with surgical or radiological drainage when needed) in two endoscopic centres during 5 years. Interventions included: (1) over-the-scope clip (OTSC) positioning; (2) placement of a covered self-expanding metal stent (SEMS); (3) fibrin glue injection (Tissucol); and (4) endo-sponge application, according to both the endoscopic feature and patient's status. RESULTS: A total of 76 patients underwent endoscopic treatment for a leak either in the upper (47 cases) or lower (29 cases) gastrointestinal tract, and the approach was successful in 39 (83%) and 22 (75.9%) patients, respectively, accounting for an overall 80.3% success rate. Leak closure was achieved in 84.9% and 78.3% of patients managed by using a single or a combination of endoscopic devices. Overall, leak closure failed in 15 (19.7%) patients, and the surgical approach was successful in all 14 patients who underwent re-intervention, whilst one patient died due to sepsis at 7 days. CONCLUSIONS: Our data suggest that an endoscopic approach, with surgical or radiological drainage when needed, is successful and safe in the majority of patients with anastomotic gastrointestinal leaks. Therefore, an endoscopic treatment could be attempted before resorting to more invasive, costly and risky re-intervention.
Authors: R Manta; M Manno; H Bertani; C Barbera; F Pigò; V Mirante; E Longinotti; G Bassotti; R Conigliaro Journal: Endoscopy Date: 2011-03-15 Impact factor: 10.093
Authors: Raffaele Manta; Santi Mangiafico; Angelo Zullo; Helga Bertani; Angelo Caruso; Giuseppe Grande; Francesco Paolo Zito; Benedetto Mangiavillano; Luigi Pasquale; Andrea Parodi; Bastianello Germanà; Gabrio Bassotti; Fabio Monica; Maurizio Zilli; Antonio Pisani; Massimiliano Mutignani; Rita Conigliaro; Giuseppe Galloro Journal: Endosc Int Open Date: 2018-11-07
Authors: Florian Kühn; Josefine Schardey; Ulrich Wirth; Tobias Schiergens; Alexander Crispin; Nicola Beger; Dorian Andrade; Moritz Drefs; Petra Zimmermann; Maria Burian; Joachim Andrassy; Jens Werner Journal: Int J Colorectal Dis Date: 2021-11-24 Impact factor: 2.571