Technical success predicts outcomes of endoscopic GI leak closure

SAN DIEGO — Endoscopic closure of post-surgical gastrointestinal luminal leaks was both safe and effective, with immediate and long-term outcomes hinging on technical success of the procedure, according to data presented at Digestive Disease Week.

Antonio Cheesman, MD, of the department of gastroenterology at the Icahn School of Medicine at Mount Sinai, said a wide range of techniques, from conservative therapy to surgical repair, management of these GI leaks is a controversial topic.

“The aim of our study was to evaluate the outcomes and predictors of success in endoscopic closure of post-surgical GI luminal leaks,” he said in his presentation.

Researchers performed a multicenter, retrospective study at five North American referral centers comprising 55 patients who underwent 118 endoscopic closure procedures. They collected data on leak identification, endoscopic interventions and other patient demographic information.

Technical success, immediate clinical success (30 days) and long-term clinical success (90 days) served as the primary endpoint. Investigators also evaluated length of hospital stay to assess which factors were associated with efficient leak management.

Endoscopic leak management was used in several indications, including for bariatric, oncologic and other benign GI surgery. The most common closure modalities were stents, over-the-scope clips, endoscopic suturing and through-the-scope clips.

Cheesman and colleagues found that the rate of technical success for the procedures was 96.4% and the rate of immediate clinical success was 80%. The rate of long-term clinical success was also 80%, and 96.4% of those patients had previously attained immediate clinical success.

Technical success was the only factor associated with immediate clinical success (P = .04), which was in turn linked to long-term clinical success, Cheesman said.

Researchers also found that increased age, male sex, low albumin and stent use were predictors of increased length of hospital stay.

“The endoscopic closure of post-surgical GI luminal leaks has high rates of technical, short-term and long-term clinical success,” Cheesman concluded. “Further studies, however, are needed to identify optimal indications for endoscopic management.” – by Alex Young

Reference:

Cheesman AR, et al. Abstract 189. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Cheesman reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.