Endoscopic internal drainage using transmural double-pigtail stents in leaks following upper gastrointestinal tract surgery

• Esteban Fuentes-Valenzuela ^[1] ; Francisco Javier García-Alonso ^[1] ; Javier Tejedor-Tejada ^[1] ; Rodrigo Nájera-Muñoz ^[1] ; Marina de Benito Sanz ^[1] ; Ramón Sánchez-Ocaña ^[1] ; Carlos de la Serna Higuera ^[1] ; Manuel Pérez-Miranda ^[1]
  1. [1] Hospital Universitario Pío del Río Hortega

     Hospital Universitario Pío del Río Hortega

     Valladolid, España

     
• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 113, Nº. 10, 2021, págs. 698-703
• Idioma: inglés
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• Resumen

  • Introduction: different endoscopic procedures have been proposed for the management of surgical leaks. Endoscopic internal drainage using trans-fistulary double-pigtail plastic stents has emerged as an alternative strategy, especially in fistulae presenting after laparoscopic gastric sleeve. Methods: a retrospective case series was performed at a single tertiary care center including all upper gastrointestinal post-surgical leaks primarily managed with endoscopic trans-fistulary insertion of double-pigtail plastic stents. Clinical success was defined as the absence of extravasation of oral radiographic contrast and radiological resolution of the collection with adequate oral intake Results: nine patients were included, six (66.6 %) females with a median age of 52.6 years (IQR 47-60). Five cases presented after laparoscopic gastric sleeve, two cases after distal esophagectomies, one after a Roux-en-Y gastric bypass and another one after a pancreaticoduodenectomy. Fistulae measured < 10 mm in five patients (55.6 %) and 10-20 mm in four patients (44.4 %). Six were early leaks. Technical and clinical success was achieved in nine (100 %) and seven (77.8 %) cases, respectively. Seven (77.8 %) patients required ≤ 3 endoscopic procedures. The median hospital stay after the first endoscopic procedure was 12 days (IQR 6.5-17.5 days), while the overall median time until leak healing was 118.5 days (IQR 84.5-170). One patient with a post-esophagectomy intrathoracic leak developed an esophageal-tracheal fistula 37 days after stent deployment. Conclusions: our results support the use of endoscopic internal drainage in postsurgical abdominal leaks, regardless of the type of surgery. Although only two patients with intrathoracic dehiscence were included.