Clin Endosc.  2023 Nov;56(6):693-705. 10.5946/ce.2023.043.

Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review

• Medas R
• Rodrigues-Pinto E

• KMID: 2547889
• DOI: http://doi.org/10.5946/ce.2023.043

Abstract

Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.

Keyword

Anastomotic leak; Bariatric surgery; Endoscopy; Esophagectomy; Gastrectomy; Upper gastrointestinal tract

Figure

• 

  Fig. 1. Endoscopic image of a post total gastrectomy leak (A) with an associated collection (B), with surgical drain in place. A fully covered self-expandable metal stent (28/23/28×155 mm) was placed covering the leak (C). Stent was removed 40 days later with leak resolution (D).

• 

  Fig. 2. Endoscopic image of a post Mckeown esophagectomy leak, with a surgical drain in place and a guidewire placed in the gastric lumen (A). A partially covered self-expandable metal stent (28/23/28×155 mm) was placed covering the leak (B, C), however, leak persisted after stent removal (D). Intraluminal endoscopic vacuum therapy was performed (E) with leak resolution after two sponge exchanges (F).

• 

  Fig. 3. Endoscopic image of a post-sleeve gastrectomy leak (A, B), with an associated perigastric collection, visible on fluoroscopy (C). Endoscopic internal drainage of the collection was performed with placement of one double-pigtail plastic stent (7 Fr 4 cm) across the leak orifice (D), with drainage of purulent content (E). Fluoroscopic image of the double-pigtail stent, with one extremity in the perigastric collection and the other in the gastric tube (F).

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