Endoscopic management highly successful in treatment of gastric leaks after resection for cancer
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According to a study published in Therapeutic Advances in Gastroenterology, internal endoscopic drainage should be the first line endoscopic treatment of anastomotic fistulas when possible.
“Endoscopic treatment of gastric fistulas following bariatric surgery, using an internal drainage (ID) consisting in double pigtail stents inserted through the anastomotic defect, has shown excellent results with success rates ranging from 79% to 97%,” Rachel Hallit, MD, of the department of gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, and colleagues wrote. “The concept of ID is to allow the secretions of the collection to drain through and around the double pigtail stent, maintaining the parietal defect open, to avoid a premature closure of the fistula. The double pigtail stent is extracted endoscopically or migrates spontaneously once the cavity is filled with granulation tissue. Therefore, these double pigtail stents have been incorporated into the clinical endoscopic practice of expert centers over the last years. However, their clinical contribution has only been scarcely reported in the setting of esophageal or gastric resections for malignancies. Our aim was to report the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for cancer.”
Between January 2016 and December 2018, Hallit and colleagues performed a multicenter retrospective study at four digestive endoscopy tertiary referral centers in France and identified 68 patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies. Patients’ mean age was 61 years. The efficacy of the endoscopy management on leak closure served at the primary outcome.
Study data showed 44% of patients had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy and 40% a total gastrectomy. The investigators reported that endoscopic treatment was successful in 90% of patients.
According to researchers, the efficacy of internal drainage was 95% and 77% for esophageal stents. The mortality rate was 3%. The initial use of internal drainage was the only predictive factor for successful endoscopic treatment (P = .002).
“Endoscopic therapy for postoperative anastomotic leak after esophageal or gastric resection is highly effective and may avoid surgical revision,” the researchers wrote. “Endoscopic ID using double pigtail stents is a novel and promising treatment modality, providing better treatment outcomes than esophageal metal stents. Our data support the use of this technique as a primary endoscopic treatment modality, whenever the size of the anastomotic defect allows it. Further studies are needed to clarify the respective role of each endoscopic treatment modality.”
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