PMID- 33075368
OWN - NLM
STAT- MEDLINE
DCOM- 20210602
LR  - 20210602
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 93
IP  - 6
DP  - 2021 Jun
TI  - Retrospective multicenter study on endoscopic treatment of upper GI postsurgical 
      leaks.
PG  - 1283-1299.e2
LID - S0016-5107(20)34879-3 [pii]
LID - 10.1016/j.gie.2020.10.015 [doi]
AB  - BACKGROUND AND AIMS: Therapeutic endoscopy plays a critical role in the 
      management of upper GI (UGI) postsurgical leaks. Data are scarce regarding 
      clinical success and safety. Our aim was to evaluate the effectiveness of 
      endoscopic therapy for UGI postsurgical leaks and associated adverse events (AEs) 
      and to identify factors associated with successful endoscopic therapy and AE 
      occurrence. METHODS: This was a retrospective, multicenter, international study 
      of all patients who underwent endoscopic therapy for UGI postsurgical leaks 
      between 2014 and 2019. RESULTS: Two hundred six patients were included. Index 
      surgery most often performed was sleeve gastrectomy (39.3%), followed by 
      gastrectomy (23.8%) and esophagectomy (22.8%). The median time between index 
      surgery and commencement of endoscopic therapy was 16 days. Endoscopic closure 
      was achieved in 80.1% of patients after a median follow-up of 52 days 
      (interquartile range, 33-81.3). Seven hundred seventy-five therapeutic 
      endoscopies were performed. Multimodal therapy was needed in 40.8% of patients. 
      The cumulative success of leak resolution reached a plateau between the third and 
      fourth techniques (approximately 70%-80%); this was achieved after 125 days of 
      endoscopic therapy. Smaller leak initial diameters, hospitalization in a general 
      ward, hemodynamic stability, absence of respiratory failure, previous 
      gastrectomy, fewer numbers of therapeutic endoscopies performed, shorter length 
      of stay, and shorter times to leak closure were associated with better outcomes. 
      Overall, 102 endoscopic therapy-related AEs occurred in 81 patients (39.3%), with 
      most managed conservatively or endoscopically. Leak-related mortality rate was 
      12.4%. CONCLUSIONS: Multimodal therapeutic endoscopy, despite being 
      time-consuming and requiring multiple procedures, allows leak closure in a 
      significant proportion of patients with a low rate of severe AEs.
CI  - Copyright (c) 2021 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Rodrigues-Pinto, Eduardo
AU  - Rodrigues-Pinto E
AD  - Gastroenterology Department, Centro Hospitalar Sao Joao, Porto, Portugal.
FAU - Pereira, Pedro
AU  - Pereira P
AD  - Gastroenterology Department, Centro Hospitalar Sao Joao, Porto, Portugal.
FAU - Sousa-Pinto, Bernardo
AU  - Sousa-Pinto B
AD  - MEDCIDS, Department of Community Medicine, Information and Health Decision 
      Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS, 
      Center for Health Technology and Services Research, Porto, Portugal.
FAU - Shehab, Hany
AU  - Shehab H
AD  - Gastroenterology Department, Cairo University Hospital, Cairo, Egypt.
FAU - Pinho, Rolando
AU  - Pinho R
AD  - Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila 
      Nova de Gaia, Portugal.
FAU - Larsen, Michael C
AU  - Larsen MC
AD  - Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Irani, Shayan
AU  - Irani S
AD  - Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Kozarek, Richard A
AU  - Kozarek RA
AD  - Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, 
      Seattle, Washington, USA.
FAU - Capogreco, Antonio
AU  - Capogreco A
AD  - Digestive Endoscopy Unit, Humanitas Research Hospital, Humanitas University, 
      Milan, Italy.
FAU - Repici, Alessandro
AU  - Repici A
AD  - Digestive Endoscopy Unit, Humanitas Research Hospital, Humanitas University, 
      Milan, Italy.
FAU - Shemmeri, Ealaf
AU  - Shemmeri E
AD  - Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington, USA.
FAU - Louie, Brian E
AU  - Louie BE
AD  - Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington, USA.
FAU - Rogalski, Pawel
AU  - Rogalski P
AD  - Department of Gastroenterology and Internal Medicine, Medical University of 
      Bialystok, Bialystok, Poland.
FAU - Baniukiewicz, Andrzej
AU  - Baniukiewicz A
AD  - Department of Gastroenterology and Internal Medicine, Medical University of 
      Bialystok, Bialystok, Poland.
FAU - Dabrowski, Andrzej
AU  - Dabrowski A
AD  - Department of Gastroenterology and Internal Medicine, Medical University of 
      Bialystok, Bialystok, Poland.
FAU - Correia de Sousa, Joao
AU  - Correia de Sousa J
AD  - Department of Gastroenterology, Hospital de Santo Antonio/Centro Hospitalar do 
      Porto, Porto, Portugal.
FAU - Barrias, Silvia
AU  - Barrias S
AD  - Department of Gastroenterology, Hospital de Santo Antonio/Centro Hospitalar do 
      Porto, Porto, Portugal.
FAU - Ichkhanian, Yervant
AU  - Ichkhanian Y
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Kumbhari, Vivek
AU  - Kumbhari V
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Bowers, Nicole
AU  - Bowers N
AD  - Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, 
      Michigan, USA.
FAU - Schulman, Allison R
AU  - Schulman AR
AD  - Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, 
      Michigan, USA.
FAU - Macedo, Guilherme
AU  - Macedo G
AD  - Gastroenterology Department, Centro Hospitalar Sao Joao, Porto, Portugal.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20201017
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
CIN - Gastrointest Endosc. 2021 Jun;93(6):1300-1303. PMID: 33712226
MH  - *Anastomotic Leak/surgery
MH  - Endoscopy
MH  - *Gastrectomy/adverse effects
MH  - Humans
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2020/10/20 06:00
MHDA- 2021/06/03 06:00
CRDT- 2020/10/19 20:09
PHST- 2020/07/22 00:00 [received]
PHST- 2020/10/09 00:00 [accepted]
PHST- 2020/10/20 06:00 [pubmed]
PHST- 2021/06/03 06:00 [medline]
PHST- 2020/10/19 20:09 [entrez]
AID - S0016-5107(20)34879-3 [pii]
AID - 10.1016/j.gie.2020.10.015 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2021 Jun;93(6):1283-1299.e2. doi: 10.1016/j.gie.2020.10.015. 
      Epub 2020 Oct 17.