Clin Endosc.  2022 May;55(3):401-407. 10.5946/ce.2021.197.

Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

• Toh BC
• Chong J
• Yeung BP
• Lim CH
• Lim EK
• Chan WH
• Tan JT

• KMID: 2529962
• DOI: http://doi.org/10.5946/ce.2021.197

Abstract

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.

Keyword

Anastomotic leak; Drainage; Stents; Upper gastrointestinal tract

Figure

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  Fig. 1. Endoscopic view of the healing process of anastomotic leak. (A) Esophagojejunal anastomotic leak (arrows). (B) Prior to removal of the pigtail stent. (C, D) Three months later.

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  Fig. 2. Fluoroscopy view during endoscopic internal drainage. (A) Perianastomotic collection (arrow). (B) A guidewire was inserted into the perianastomotic collection cavity under radiological guidance before double pigtail stent deployment. (C) Six weeks later, no obvious contrast leaks were observed (arrow). All contrast flowed into the jejunum. A small amount of contrast in the remnant cavity traveled from double pigtail stent in situ.

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  Fig. 3. Abdominal computed tomography findings pre- and postendoscopic internal drainage (EID) insertion. (A) Pre-EID: perianastomotic collection was demonstrated (arrow). (B) Post-EID: the size of perianastomotic collection decreased and any contrast leakage into collection was not seen.

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