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Rodrigues-Pinto E, Ferreira-Silva J, Siersema PD. How to Prevent and Treat the Most Frequent Adverse Events Related to Luminal Dilation and Stenting in Benign Disease. Am J Gastroenterol 2023; 118:1521-1527. [PMID: 36946679 DOI: 10.14309/ajg.0000000000002260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joel Ferreira-Silva
- Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Pokala A, Shen B. Endoscopic Treatment of Acute and Chronic Anastomotic Leaks from Inflammatory Bowel Disease Surgery. Gastrointest Endosc Clin N Am 2022; 32:801-815. [PMID: 36202517 DOI: 10.1016/j.giec.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Acute or chronic anastomotic leak is a common complication after any gastrointestinal surgery in inflammatory bowel disease (IBD). The underlying disease of the bowel, comorbidities, malnutrition, anemia, and concurrent use of corticosteroids increase the risk for the development of anastomotic leaks. Anastomotic leak is traditionally managed with surgery. However, recent innovation has allowed the use of endoscopic methods in the management of some anastomotic leaks and their consequences. This article discusses a variety of endoscopic techniques that have either been established or are under current evaluation, for the management of anastomotic leaks in patients with IBD.
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Affiliation(s)
- Aditya Pokala
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, Herbert Irving Pavilion Suite 843, 161 Ft Washington Avenue, New York, NY 10032, USA
| | - Bo Shen
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, Herbert Irving Pavilion Suite 843, 161 Ft Washington Avenue, New York, NY 10032, USA.
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Futuristic Developments and Applications in Endoluminal Stenting. Gastroenterol Res Pract 2022; 2022:6774925. [PMID: 35069729 PMCID: PMC8767390 DOI: 10.1155/2022/6774925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022] Open
Abstract
Endoscopic stenting is a well-established option for the treatment of malignant obstruction, temporary management of benign strictures, and sealing transmural defects, as well as drainage of pancreatic fluid collections and biliary obstruction. In recent years, in addition to expansion in indications for endoscopic stenting, considerable strides have been made in stent technology, and several types of devices with advanced designs and materials are continuously being developed. In this review, we discuss the important developments in stent designs and novel indications for endoluminal and transluminal stenting. Our discussion specifically focuses on (i) biodegradable as well as (ii) irradiating and drug-eluting stents for esophageal, gastroduodenal, biliary, and colonic indications, (iii) endoscopic stenting in inflammatory bowel disease, and (iv) lumen-apposing metal stent.
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Jung CFM, Hallit R, Müller-Dornieden A, Calmels M, Goere D, Chaput U, Camus M, Gonzalez JM, Barthet M, Jacques J, Legros R, Barrioz T, Kück F, Seif Amir Hosseini A, Ghadimi M, Kunsch S, Ellenrieder V, Wedi E, Barret M. Endoscopic internal drainage and low negative-pressure endoscopic vacuum therapy for anastomotic leaks after oncologic upper gastrointestinal surgery. Endoscopy 2022; 54:71-74. [PMID: 33506454 DOI: 10.1055/a-1375-8151] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Endoscopic internal drainage (EID) with double-pigtail stents or low negative-pressure endoscopic vacuum therapy (EVT) are treatment options for leakage after upper gastrointestinal oncologic surgery. We aimed to compare the effectiveness of these techniques. METHODS Between 2016 and 2019, patients treated with EID in five centers in France and with EVT in Göttingen, Germany were included and retrospectively analyzed using univariate analysis. Pigtail stents were changed every 4 weeks; EVT was repeated every 3-4 days until leak closure. RESULTS 35 EID and 27 EVT patients were included, with a median (interquartile range [IQR]) leak size of 0.75 cm (0.5-1.5). Overall treatment success was 100 % (95 % confidence interval [CI] 90 %-100 %) for EID vs. 85.2 % (95 %CI 66.3 %-95.8 %) for EVT (P = 0.03). The median (IQR) number of endoscopic procedures was 2 (2-3) vs. 3 (2-6.5; P = 0.003) and the median (IQR) treatment duration was 42 days (28-60) vs. 17 days (7.5-28; P < 0.001), for EID vs. EVT, respectively. CONCLUSION EID and EVT provide high closure rates for upper gastrointestinal anastomotic leaks. EVT provides a shorter treatment duration, at the cost of a higher number of procedures.
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Affiliation(s)
- Carlo Felix Maria Jung
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Rachel Hallit
- Department of Gastroenterology and Gastrointestinal Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Annegret Müller-Dornieden
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Mélanie Calmels
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Diane Goere
- Department of Digestive Surgery, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Ulriikka Chaput
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Marine Camus
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Jean Michel Gonzalez
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Thierry Barrioz
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Fabian Kück
- Department of Medical Statistics, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Kunsch
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Edris Wedi
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany.,Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum Offenbach, Offenbach, Germany
| | - Maximilien Barret
- Department of Gastroenterology and Gastrointestinal Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
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Abstract
A comprehensive understanding of gastrointestinal anatomy is essential for performance of any endoscopic procedure. Surgical approaches to therapy have become increasingly common in the past decade, which has resulted in a substantial proportion of patients with surgically altered anatomy who require endoscopy. In parallel with the obesity epidemic, bariatric surgery for obesity management has been widely adopted. In response to these trends, gastroenterologists must become familiar with patient anatomy after these surgical interventions and understand the implications of this altered anatomy on the current array of available endoscopic modalities for diagnosis and therapy. This review describes the range of surgically altered anatomy commonly encountered in the upper gastrointestinal tract. For each foregut location-esophagus, stomach, and small bowel-we describe indications for and specific details of the range of common surgical approaches affecting this regional anatomy. We then provide an endoscopic roadmap through the altered anatomy resulting from these surgical interventions. Finally, we address the impact of postsurgical anatomy on performance of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography, with guidance surrounding how to successfully execute these procedures. Evolution of endoscopic approaches over time might be expected to enhance the safety and efficacy of these interventions in patients with surgically altered anatomy.
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Hetoja S, De Pasqual CA, Mengardo V, Weindelmayer J, Giacopuzzi S. Gastric conduit perforation after Ivor Lewis esophagectomy successfully treated with endoscopic vacuum therapy (E-VAC): a case report. J Surg Case Rep 2020; 2020:rjaa251. [PMID: 32850114 PMCID: PMC7440394 DOI: 10.1093/jscr/rjaa251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
Abstract
Gastric conduit perforation is a life-threatening complication after esophagectomy and currently there is no consensus about its optimal management. Endoscopic vacuum therapy (E-VAC) is a promising technique for the treatment of leaks and perforations after upper gastro-intestinal surgery. We report the case of a 65 years-old male patient who underwent an Ivor Lewis esophagectomy for esophago-gastric junction adenocarcinoma. He referred to our Emergency Department for septic shock and right hydropneumothorax. We performed an emergency thoracoscopy with intraoperative esophagogastroduodenoscopy which showed a pre-pyloric perforation of the gastric conduit. The perforation was initially treated with unsuccessful primary surgical closure and subsequently by means of E-VAC, firstly placed intraluminal and then intracavitary. With the latter technique, we assisted to a progressive clinical improvement until the definitive healing of the perforation. To our knowledge, this is the first case of a gastric tube perforation after esophagectomy successfully treated with E-VAC.
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Affiliation(s)
- Selma Hetoja
- Division of General and Upper GI Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Carlo Alberto De Pasqual
- Division of General and Upper GI Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Valentina Mengardo
- Division of General and Upper GI Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Jacopo Weindelmayer
- Division of General and Upper GI Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- Division of General and Upper GI Surgery, Department of Surgery, University of Verona, Verona, Italy
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Rodrigues-Pinto E, Costa-Moreira P, Santos AL, Dias E, Macedo G. Endoscopic removal of migrated Nissen fundoplication mesh. VideoGIE 2020; 5:238-240. [PMID: 32529156 PMCID: PMC7277046 DOI: 10.1016/j.vgie.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Morais R, Vilas-Boas F, Silva M, Pereira P, Macedo G. Endoscopic Vacuum Therapy for Esophageal Perforation Treatment after Foreign Body Ingestion: Resolution after a Single Session. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:207-209. [PMID: 32509928 PMCID: PMC7250350 DOI: 10.1159/000503011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Rui Morais
- *Rui Morais, Gastroenterology Department, Hospital de São João, Alameda Professor Hernâni Monteiro, PT–4200-319 Porto (Portugal), E-Mail
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Rodrigues-Pinto E, Repici A, Donatelli G, Macedo G, Devière J, van Hooft JE, Campos JM, Galvao Neto M, Silva M, Eisendrath P, Kumbhari V, Khashab MA. International multicenter expert survey on endoscopic treatment of upper gastrointestinal anastomotic leaks. Endosc Int Open 2019; 7:E1671-E1682. [PMID: 31788551 PMCID: PMC6877414 DOI: 10.1055/a-1005-6632] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022] Open
Abstract
Background and study aims A variety of endoscopic techniques are currently available for treatment of upper gastrointestinal (UGI) anastomotic leaks; however, no definite consensus exists on the most appropriate therapeutic approach. Our aim was to explore current management of UGI anastomotic leaks. Methods A survey questionnaire was distributed among international expert therapeutic endoscopists regarding management of UGI anastomotic leaks. Results A total of 44 % of 163 surveys were returned; 69 % were from gastroenterologists and 56 % had > 10 years of experience. A third of respondents treat between 10 and 19 patients annually. Fifty-six percent use fully-covered self-expandable metal stents as their usual first option; 80% use techniques to minimize migration; 4 weeks was the most common reported stent dwell time. Sixty percent perform epithelial ablation prior to over-the-scope-clip placement or suturing. Regarding endoscopic vacuum therapy (EVT), 56 % perform balloon dilation and intracavitary EVT in patients with large cavities but small leak defects. Regarding endoscopic septotomy, 56 % consider a minimal interval of 4 weeks from surgery and 90 % consider the need to perform further sessions. Regarding endoscopic internal drainage (EID), placement of two stents and shorter stents is preferred. Persistent inflammation with clinical sepsis was the definition most commonly reported for endoscopic failure. EVT/stent placement and EVT/EID were the therapeutic options most often chosen in patients with previous oncologic surgery and previous bariatric surgery, respectively. Conclusions There is a wide variation in the management of patients with UGI anastomotic leaks. Future prospective studies are needed to move from an expert- to evidence- and personalization-based care.
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Affiliation(s)
- Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal,Corresponding author Eduardo Rodrigues-Pinto, MD Gastroenterology DepartmentCentro Hospitalar São JoãoPorto. Al. Prof. Hernâni Monteiro 4200 – 319PortoPortugal+351 22 551 3601
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan; Humanitas University, Rozzano, Milan, Italy
| | - Gianfranco Donatelli
- Department of Gastroenterology and Hepatology, Hôpital Privé des Peupliers Paris, France
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Jacques Devière
- Department of Gastroenterology Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Manoel Galvao Neto
- Herbert Wertheim College of Medicine at Florida International University, Department of Surgery, Miami, Florida, United States
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Pierre Eisendrath
- Department of Gastroenterology & Hepatology, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Vivek Kumbhari
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
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Abstract
Background and Aims Therapeutic endoscopy plays a major role in the management of postbariatric anastomotic leaks, offering an effective treatment alternative to repeated surgery. In recent years, management has been moving from bridging and closing the leak’s orifice toward an approach that uses vacuum therapy or internal drainage. Our aim was to demonstrate different treatment options for the management of postbariatric leaks. Methods We describe 3 different endoscopic techniques for postbariatric leaks in 2 patients who had undergone Roux-en-Y gastric bypass (RYGB) and 1 patient who had undergone sleeve gastrectomy. Results The first patient had a 20-mm early post-RYGB leak with an intra-abdominal associated collection treated with 5 sessions of endoscopic vacuum therapy (EVT). The second patient had a 12-mm acute postgastric sleeve leak with an associated collection, in whom therapy with EVT had failed, and who was then treated with endoscopic internal drainage (EID). The last patient had a chronic intra-abdominal collection after RYGB, despite reoperation, in whom therapy with EID and esophageal stent had failed, and who was treated with a diabolo-shaped lumen-apposing metal stent placed between the gastric pouch and the gastric remnant. Weight-loss intention was not compromised in any patient. All patients remain well. Conclusions Staple-line or anastomotic leaks are an important cause of morbidity and mortality after surgery. There are myriad endoscopic techniques, with varying reported efficacy. Often, more than one endoscopic approach can be used concomitantly, whereas in other cases, therapies are applied sequentially depending on the initial clinical response. Multiple therapeutic options should be considered before endoscopic failure.
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