TY - JOUR
T1 - Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks
AU - Rodrigues-Pinto, Eduardo
AU - Pereira, Pedro
AU - Sousa-Pinto, Bernardo
AU - Shehab, Hany
AU - Pinho, Rolando
AU - Larsen, Michael C.
AU - Irani, Shayan
AU - Kozarek, Richard A.
AU - Capogreco, Antonio
AU - Repici, Alessandro
AU - Shemmeri, Ealaf
AU - Louie, Brian E.
AU - Rogalski, Pawel
AU - Baniukiewicz, Andrzej
AU - Dabrowski, Andrzej
AU - Correia de Sousa, João
AU - Barrias, Silvia
AU - Ichkhanian, Yervant
AU - Kumbhari, Vivek
AU - Khashab, Mouen A.
AU - Bowers, Nicole
AU - Schulman, Allison R.
AU - Macedo, Guilherme
N1 - Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy
PY - 2021/6
Y1 - 2021/6
N2 - Background and Aims: Therapeutic endoscopy plays a critical role in the management of upper GI (UGI) postsurgical leaks. Data are scarce regarding clinical success and safety. Our aim was to evaluate the effectiveness of endoscopic therapy for UGI postsurgical leaks and associated adverse events (AEs) and to identify factors associated with successful endoscopic therapy and AE occurrence. Methods: This was a retrospective, multicenter, international study of all patients who underwent endoscopic therapy for UGI postsurgical leaks between 2014 and 2019. Results: Two hundred six patients were included. Index surgery most often performed was sleeve gastrectomy (39.3%), followed by gastrectomy (23.8%) and esophagectomy (22.8%). The median time between index surgery and commencement of endoscopic therapy was 16 days. Endoscopic closure was achieved in 80.1% of patients after a median follow-up of 52 days (interquartile range, 33-81.3). Seven hundred seventy-five therapeutic endoscopies were performed. Multimodal therapy was needed in 40.8% of patients. The cumulative success of leak resolution reached a plateau between the third and fourth techniques (approximately 70%-80%); this was achieved after 125 days of endoscopic therapy. Smaller leak initial diameters, hospitalization in a general ward, hemodynamic stability, absence of respiratory failure, previous gastrectomy, fewer numbers of therapeutic endoscopies performed, shorter length of stay, and shorter times to leak closure were associated with better outcomes. Overall, 102 endoscopic therapy–related AEs occurred in 81 patients (39.3%), with most managed conservatively or endoscopically. Leak-related mortality rate was 12.4%. Conclusions: Multimodal therapeutic endoscopy, despite being time-consuming and requiring multiple procedures, allows leak closure in a significant proportion of patients with a low rate of severe AEs.
AB - Background and Aims: Therapeutic endoscopy plays a critical role in the management of upper GI (UGI) postsurgical leaks. Data are scarce regarding clinical success and safety. Our aim was to evaluate the effectiveness of endoscopic therapy for UGI postsurgical leaks and associated adverse events (AEs) and to identify factors associated with successful endoscopic therapy and AE occurrence. Methods: This was a retrospective, multicenter, international study of all patients who underwent endoscopic therapy for UGI postsurgical leaks between 2014 and 2019. Results: Two hundred six patients were included. Index surgery most often performed was sleeve gastrectomy (39.3%), followed by gastrectomy (23.8%) and esophagectomy (22.8%). The median time between index surgery and commencement of endoscopic therapy was 16 days. Endoscopic closure was achieved in 80.1% of patients after a median follow-up of 52 days (interquartile range, 33-81.3). Seven hundred seventy-five therapeutic endoscopies were performed. Multimodal therapy was needed in 40.8% of patients. The cumulative success of leak resolution reached a plateau between the third and fourth techniques (approximately 70%-80%); this was achieved after 125 days of endoscopic therapy. Smaller leak initial diameters, hospitalization in a general ward, hemodynamic stability, absence of respiratory failure, previous gastrectomy, fewer numbers of therapeutic endoscopies performed, shorter length of stay, and shorter times to leak closure were associated with better outcomes. Overall, 102 endoscopic therapy–related AEs occurred in 81 patients (39.3%), with most managed conservatively or endoscopically. Leak-related mortality rate was 12.4%. Conclusions: Multimodal therapeutic endoscopy, despite being time-consuming and requiring multiple procedures, allows leak closure in a significant proportion of patients with a low rate of severe AEs.
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U2 - 10.1016/j.gie.2020.10.015
DO - 10.1016/j.gie.2020.10.015
M3 - Article
C2 - 33075368
AN - SCOPUS:85098632441
SN - 0016-5107
VL - 93
SP - 1283-1299.e2
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 6
ER -