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Principles of Flexible Endoscopy for Surgeons pp 129–138Cite as

Endoscopic Tools and Techniques for Fistula and Leaks

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Abstract

Since the first attempts at intestinal anastomoses, leaks and fistulas have been a constant problem. In particular, the rising prevalence of morbid obesity and corresponding increase in the volume of bariatric surgery have led to a mounting experience with associated gastrointestinal anastomotic complications. Anastomotic or staple-line leaks after gastrointestinal surgery are relatively uncommon complications, but quite morbid and potentially lethal.

Although it is a relatively uncommon surgery, esophagectomy has a substantial risk of anastomotic leak or fistulization due to its lack of serosa and relative ischemia of its reconstruction options. There is between a 3 and 21 % rate of esophageal anastomotic leaks and they can become fistulas to mediastinal structures including vascular (usually fatal) or pulmonary (highly morbid). There are also a small, but real, incidence of spontaneous (Boerhaave’s) and iatrogenic upper gastrointestinal tract perforations.

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Author information

Authors and Affiliations

  1. Department of General and Minimally Invasive Surgery, Oregon Clinic, Portland, OR, USA

    Ahmed Sharata M.D.

  2. Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Oregon Health and Sciences University, Portland, OR, USA

    Lee L. Swanstrom M.D.

Authors
  1. Ahmed Sharata M.D.
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  2. Lee L. Swanstrom M.D.
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Corresponding author

Correspondence to Lee L. Swanstrom M.D. .

Editor information

Editors and Affiliations

  1. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Jeffrey M. Marks

  2. The Methodist Hospital, Methodist Institute for Technology, Innovation and Education, Houston, Texas, USA

    Brian J. Dunkin

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Endoscopic bronchoesophageal fistula closure (MOV 255395 kb)

OTSC clip for flexible endoscopy (MOV 305025 kb)

OS for approximation of anastomatic leaks and fixation of stent (MOV 190658 kb)

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Sharata, A., Swanstrom, L.L. (2013). Endoscopic Tools and Techniques for Fistula and Leaks. In: Marks, J., Dunkin, B. (eds) Principles of Flexible Endoscopy for Surgeons. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6330-6_12

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  • DOI: https://doi.org/10.1007/978-1-4614-6330-6_12

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6329-0

  • Online ISBN: 978-1-4614-6330-6

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