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Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage

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Abstract

Background

The purpose of this study was to evaluate the safety and efficacy of endoscopic therapy, an alternative and less invasive modality for the management of leakage after gastrectomy.

Methods

An electronic database of 35 patients with anastomotic leaks after surgery for stomach cancer that were treated with either an endoscopic procedure or surgery between January 2004 and March 2012 was reviewed. The success rates and safety of both modalities were evaluated.

Results

Endoscopic treatment was performed in 20 patients and surgical treatment in 15 patients. The median time interval between the primary surgery and diagnosis of leakage was 8.0 days (interquartile range, 5.0–14.0 days). Of the 20 patients with endoscopic treatment, technical success was achieved in 19 patients (95 %) with resulting clinical success achieved in all of these 19 patients (100 %). One patient with failed endoscopic management went on to receive surgery. There were no cases of leakage-related deaths after endoscopic treatment. Of the 15 patients with surgical treatment, 5 died due to sepsis, bleeding, or hospital-acquired pneumonia. For diagnosis of leakage, 17 patients from the endoscopy group underwent computed tomography (CT) scanning, which revealed leakages in 3 patients (17.6 %) and occult leakages were subsequently defined at fluoroscopy in all 20 patients. Seven of twelve patients (58.3 %) from the surgical group had leakages diagnosed by CT scan.

Conclusions

Endoscopic treatment can be considered a valuable option for the management of postoperative anastomotic leakage with a high degree of technical feasibility and safety, particularly for leakages that are not excessively large.

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Disclosures

Seohyun Lee, Ji Yong Ahn, Hwoon-Yong Jung, Jeong Hoon Lee, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim, Beom Su Kim, Jeong Hwan Yook, Sung Tae Oh, Byung Sik Kim, and Seungbong Han have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea

    Seohyun Lee, Ji Yong Ahn, Hwoon-Yong Jung, Jeong Hoon Lee, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee & Jin-Ho Kim

  2. Department of Surgery, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, Seoul, Korea

    Beom Su Kim, Jeong Hwan Yook, Sung Tae Oh & Byung Sik Kim

  3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, Seoul, Korea

    Seungbong Han

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  1. Seohyun Lee
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  2. Ji Yong Ahn
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  8. Ho June Song
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  9. Gin Hyug Lee
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  11. Beom Su Kim
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  13. Sung Tae Oh
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  14. Byung Sik Kim
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  15. Seungbong Han
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Corresponding author

Correspondence to Seohyun Lee.

Additional information

Seohyun Lee and Ji Yong Ahn have contributed equally to this study.

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Lee, S., Ahn, J.Y., Jung, HY. et al. Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc 27, 4232–4240 (2013). https://doi.org/10.1007/s00464-013-3028-y

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  • DOI: https://doi.org/10.1007/s00464-013-3028-y

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