Clinical Endoscopy

  • 제55권3호
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  • Pages.401-407
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  • 2022
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
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Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

  • Bin Chet Toh (Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital) ;
  • Jingli Chong (Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital) ;
  • Baldwin PM Yeung (Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital) ;
  • Chin Hong Lim (Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital) ;
  • Eugene KW Lim (Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital) ;
  • Weng Hoong Chan (Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital) ;
  • Jeremy TH Tan (Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital)
  • 투고 : 2021.06.29
  • 심사 : 2021.09.02
  • 발행 : 2022.05.30
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초록

Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

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참고문헌

  1. Lang H, Piso P, Stukenborg C, et al. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 2000;26:168-171. https://doi.org/10.1053/ejso.1999.0764
  2. Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg 2009;13:239-245. https://doi.org/10.1007/s11605-008-0716-3
  3. Carboni F, Valle M, Federici O, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol 2016;7:515-522. https://doi.org/10.21037/jgo.2016.06.02
  4. Yoo HM, Lee HH, Shim JH, et al. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol 2011;104:734-740. https://doi.org/10.1002/jso.22045
  5. Li QG, Li P, Tang D, et al. Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol 2013;19:4060-4065. https://doi.org/10.3748/wjg.v19.i25.4060
  6. Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 2004;198:42-50. https://doi.org/10.1016/j.jamcollsurg.2003.08.007
  7. Rogalski P, Daniluk J, Baniukiewicz A, et al. Endoscopic management of gastrointestinal perforations, leaks and fistulas. World J Gastroenterol 2015;21:10542-10552. https://doi.org/10.3748/wjg.v21.i37.10542
  8. Bemelman WA, Baron TH. Endoscopic management of transmural defects, including leaks, perforations, and fistulae. Gastroenterology 2018;154:1938-1946.e1. https://doi.org/10.1053/j.gastro.2018.01.067
  9. Kahler G. Anastomotic leakage after upper gastrointestinal surgery: endoscopic treatment. Visc Med 2017;33:202-206. https://doi.org/10.1159/000475783
  10. Willingham FF, Buscaglia JM. Endoscopic management of gastrointestinal leaks and fistulae. Clin Gastroenterol Hepatol 2015;13:1714-1721. https://doi.org/10.1016/j.cgh.2015.02.010
  11. Hummel R, Bausch D. Anastomotic leakage after upper gastrointestinal surgery: surgical treatment. Visc Med 2017;33:207-211. https://doi.org/10.1159/000470884
  12. Talbot M, Yee G, Saxena P. Endoscopic modalities for upper gastrointestinal leaks, fistulae and perforations. ANZ J Surg 2017;87:171-176. https://doi.org/10.1111/ans.13355
  13. Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 2010;20:403-409. https://doi.org/10.1007/s11695-009-0020-7
  14. Johnson MD, Walsh RM, Henderson JM, et al. Surgical versus nonsurgical management of pancreatic pseudocysts. J Clin Gastroenterol 2009;43:586-590. https://doi.org/10.1097/MCG.0b013e31817440be
  15. Akshintala VS, Saxena P, Zaheer A, et al. A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts. Gastrointest Endosc 2014;79:921-928. https://doi.org/10.1016/j.gie.2013.10.032
  16. Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013;145:583-590.e1. https://doi.org/10.1053/j.gastro.2013.05.046
  17. Foo JW, Balshaw J, Tan MH, et al. Leaks in fixed-ring banded sleeve gastrectomies: a management approach. Surg Obes Relat Dis 2017;13:1259-1264. https://doi.org/10.1016/j.soard.2017.03.031
  18. Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 2015;25:1293-1301. https://doi.org/10.1007/s11695-015-1675-x
  19. Donatelli G, Dumont JL, Cereatti F, et al. Endoscopic internal drainage as first-line treatment for fistula following gastrointestinal surgery: a case series. Endosc Int Open 2016;4:E647-E651. https://doi.org/10.1055/s-0042-105206
  20. Lorenzo D, Guilbaud T, Gonzalez JM, et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc 2018;87:429-437. https://doi.org/10.1016/j.gie.2017.07.032
  21. Rodrigues-Pinto E, Pereira P, Sousa-Pinto B, et al. Retrospective multicenter study on endoscopic treatment of upper GI postsurgical leaks. Gastrointest Endosc 2021;93:1283-1299.e2. https://doi.org/10.1016/j.gie.2020.10.015
  22. Jung CF, Hallit R, Muller-Dornieden A, et al. Endoscopic internal drainage and low negative-pressure endoscopic vacuum therapy for anastomotic leaks after oncologic upper gastrointestinal surgery. Endoscopy 2022;54:71-74. https://doi.org/10.1055/a-1375-8151
  23. Still S, Mencio M, Ontiveros E, et al. Primary and rescue endoluminal vacuum therapy in the management of esophageal perforations and leaks. Ann Thorac Cardiovasc Surg 2018;24:173-179. https://doi.org/10.5761/atcs.oa.17-00107