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Clinical Outcomes of Postoperative Upper Gastrointestinal Leakage According to Treatment Modality

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Abstract

Background & Aim

We evaluated the clinical outcomes according to treatment modality for gastrointestinal anastomotic leakage.

Methods

Of the 19,207 patients who underwent gastrectomy for gastric cancer from March 2000 to April 2013, we retrospectively analyzed the 133 cases who developed anastomotic leakage. These patients were treated using endoscopic management, surgery, or conservative management (endoscopic treatment was introduced in 2009). To evaluate the efficacy of endoscopic treatment, we compared the clinical outcomes between the conservative management-only group before 2009 and the conservative or endoscopic management group from 2009; and between the surgical management-only group before 2009 and the surgical or endoscopic management group from 2009.

Results

Seventy-three were initially managed conservatively, 35 were treated surgically, and 25 were treated using endoscopic procedures. Chronologically comparing each treatment group as ‘before 2009’ (n = 54) and ‘from 2009’ (n = 79), there were differences in the length of hospital stay (median 32 versus 27, p = 0.048) and duration of antibiotic use (median 28 versus 20, p = 0.013). Patients who underwent conservative or endoscopic management from 2009 showed a shorter hospital stay, period of fasting, and duration of antibiotic use than patients who underwent only conservative management before 2009. Patients who received surgery or endoscopic management from 2009 showed a shorter hospital stay and duration of antibiotic use than patients who underwent only surgery before 2009.

Conclusion

Endoscopic management for selected cases can reduce duration of hospital stay and antibiotic administration in the treatment of anastomotic leakage after gastrectomy.

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Author’s Contribution

Hwoon-Yong Jung was helpful in study conception, design, image assessment, and supervision. Seohyun Lee and Ji Yong Ahn are acknowledged for their work in study design, review of medical records, data analysis and interpretation, image assessment, and writing of the draft. Review of medical records, data collection, image assessment, and data analysis and interpretation were performed by Jeong Hoon Lee, Do Hoon Kim, Kwi-Sook Choi, Kee Don Choi, Ho June Song, Gin Hyug Lee, Beom Su Kim, Jeong Hwan Yook, Sung Tae Oh, and Byung Sik Kim. Review of medical records and data collection were done by Seohyun Lee and Ji Yong Ahn. Seohyun Lee and Ji Yong Ahn critically revised the article for important intellectual content. Study conception and supervision were done by Jin-Ho Kim. Seohyun Lee reviewed the statistical data. Final approval was given by Hwoon-Yong Jung.

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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

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    1. Seohyun Lee
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    Correspondence to Hwoon-Yong Jung.

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

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    Lee, S., Ahn, J.Y., Jung, HY. et al. Clinical Outcomes of Postoperative Upper Gastrointestinal Leakage According to Treatment Modality. Dig Dis Sci 61, 523–532 (2016). https://doi.org/10.1007/s10620-015-3880-9

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    • DOI: https://doi.org/10.1007/s10620-015-3880-9

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