Skip to main content
SpringerLink
Log in

Endoscopic Stent Placement and Suturing: Management of Gastrointestinal Anastomotic Leaks

  • Chapter
  • First Online:
The SAGES Manual Operating Through the Endoscope

Abstract

Endoscopic therapies have evolved significantly over the past decade and allow for intervention in the management of anastomotic dehiscence in both the upper and lower gastrointestinal tract. Endoscopy allows for recognition and various management techniques in the treatment algorithm and should be considered a first-line approach for selected patients to avoid the morbidity of reoperation.

The outcome of closure depends on the technical operator expertise in the proper selection and use of various multidisciplinary approaches. More clinical experience of the endoscopist in the use of novel endoscopic stent and suturing technology will not only provide technical success but offer clinical benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Beasley WE, Jefferies MT, Gilmour J, Manson JM. A single surgeon’s series of transthoracic oesophageal resections. Ann R Coll Surg Engl. 2014;96(2):151–6.

    Article  CAS  PubMed  Google Scholar 

  2. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26:1509–15.

    Article  PubMed  Google Scholar 

  3. Csendes A, Burgos AM, Braghetto I. Classification and management of leaks after gastric bypass for patients with morbid obesity: a prospective study of 60 patients. Obes Surg. 2012;22:855–62.

    Article  PubMed  Google Scholar 

  4. Huebner M, Hubner M, Cima RR, Larson DW. Timing of complications and length of stay after rectal cancer surgery. J Am Coll Surg. 2014;218:914–9.

    Article  PubMed  Google Scholar 

  5. Lee WS, Yun SH, Roth YN, et al. Risk factors and clinical outcome for anasto-motic leakage after total mesorectal excision for rectal cancer. World J Surg. 2008;32:1124–9.

    Article  PubMed  Google Scholar 

  6. Rutegard M, Lagergren P, Rouvelas I, et al. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol. 2012;19(1):99–103.

    Article  PubMed  Google Scholar 

  7. Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg. 2004;10:71–5.

    PubMed  Google Scholar 

  8. Raju GS. Endoscopic management of gastrointestinal leaks. Gastrointest Endosc Clin N Am. 2007;17:487–503.

    Article  CAS  PubMed  Google Scholar 

  9. Martin LW, Swisher SG, Hofstetter W, et al. Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg. 2005;242:392–9.

    PubMed Central  PubMed  Google Scholar 

  10. Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg. 2005;27:3–7.

    Article  CAS  PubMed  Google Scholar 

  11. Crestanello JA, Deschamps C, Cassivi SD, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg. 2005;129:254–60.

    Article  PubMed  Google Scholar 

  12. Turkyilmaz A, Eroglu A, Aydin Y, et al. The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus. 2009;22:119–26.

    Article  CAS  PubMed  Google Scholar 

  13. van Boeckel PGA, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011;33:1292–301.

    Article  PubMed  Google Scholar 

  14. van Boeckel PGA, Dua KS, Weusten BL, et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol. 2012;12:19.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102(12):2667–77.

    Article  PubMed  Google Scholar 

  16. Hirdes MMC, Vleggaar FP, van der Linde K, Willems M, Totte E, Siersema PD. Esophageal perforation due to removal of partially covered self-expanding metal stents placed for benign perforation or leak. Endoscopy. 2011;43:156–9.

    Article  CAS  PubMed  Google Scholar 

  17. Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73:890–9.

    Article  PubMed  Google Scholar 

  18. Hirdes MMC, Siersema PD, Houben MHMG, Weusten BLAM, Vleggaar FP. Stent-in-stent technique for removal of embedded esophageal self-expanding stents. Am J Gastroenterol. 2011;106:286–93.

    Article  CAS  PubMed  Google Scholar 

  19. Hunerbein M, Stroszczynski C, et al. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg. 2004;240(5):801–7.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Kauer WK, Stein HJ, et al. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc. 2008;22(1):50–3.

    Article  PubMed  Google Scholar 

  21. Zisis C, Guillin A, Heyries L, et al. Stent placement in the management of oesophageal leaks. Eur J Cardiothorac Surg. 2008;33:451–6.

    Article  PubMed  Google Scholar 

  22. Tuebergen D, Rijcken E, Mennigen R, et al. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endolumenal stents: efficacy and current limitations. J Gastrointest Surg. 2008;12:1168–76.

    Article  PubMed  Google Scholar 

  23. Dai YY, Gretschel S, et al. Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents. Br J Surg. 2009;96(8):887–91.

    Article  CAS  PubMed  Google Scholar 

  24. Rajan PS, Bansal S, Balaji NS, et al. Role of endoscopic stents and selective minimal access drainage in oesophageal leaks: feasibility and outcome. Surg Endosc. 2014;28:2368–73.

    Article  CAS  PubMed  Google Scholar 

  25. Adler DG, McAfee M, Gostout CJ. Closure of an esophagopleural fistula by using fistula tract coagulation and an endoscopic suturing device. Gastrointest Endosc. 2001;54:652–3.

    Article  CAS  PubMed  Google Scholar 

  26. Bonin EA, Wong Kee Song LM, Gostout ZS, Bingener J, Gostout CJ. Closure of a persistent esophagopleural fistula assisted by a novel endoscopic suturing system. Endoscopy. 2012;44 Suppl 2:E8–9.

    PubMed  Google Scholar 

  27. Kurian AA, Bhayani NH, Reavis K, Dunst C, Swanstrom L. Endoscopic suture repair of full-thickness esophagotomy during per-oral esophageal myotomy for achalasia. Surg Endosc. 2013;27:3910.

    Article  PubMed  Google Scholar 

  28. Bludau M, Hölscher AH, Herbold T, Leers JM, Gutschow C, Fuchs H, Schröder W. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc. 2014;28(3):896–901. doi:10.1007/s00464-013-3244-5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Brangewitz M, Voigtländer T, Helfritz FA. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy. 2013;45(6):433–8. doi:10.1055/s-0032-1326435.

    Article  CAS  PubMed  Google Scholar 

  30. Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;1:33–8.

    Article  Google Scholar 

  31. Yimcharoen P, Heneghan HM, Tariq N, et al. Endoscopic stent management of leaks and anastomotic strictures after foregut surgery. Surg Obes Relat Dis. 2011;7:628–36.

    Article  PubMed  Google Scholar 

  32. Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75:287–93.

    Article  PubMed  Google Scholar 

  33. Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.

    Article  PubMed  Google Scholar 

  34. Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206:935–8.

    Article  PubMed  Google Scholar 

  35. Casella G, Soricelli E, Rizello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.

    Article  CAS  PubMed  Google Scholar 

  36. Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:403–9.

    Article  PubMed  Google Scholar 

  37. Pequignot A, Fuks D, Verhaeghe P, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22:712–20.

    Article  CAS  PubMed  Google Scholar 

  38. Court I, Wilson A, Benotti P, et al. T-tube gastrostomy as a novel approach for distal staple line disruption after sleeve gastrectomy for morbid obesity: case report and review of the literature. Obes Surg. 2010;20:519–22.

    Article  PubMed  Google Scholar 

  39. Merrifield BF, Wagh MS, Thompson CC. Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc. 2006;63:693–7.

    Article  PubMed  Google Scholar 

  40. Wagh MS, Merrifield BF, Thompson CC. Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc. 2006;63:473–8.

    Article  PubMed  Google Scholar 

  41. Haito-Chavez Y, Law JK, Kratt T, et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc. 2014;80(4):610–22. pii: S0016-5107(14)01334-0.

    Article  PubMed  Google Scholar 

  42. Liu L, Chiu PW, Teoh AY, Lam CC, Ng EK, Lau JY. Endoscopic suturing is superior to endoclips for closure of gastrotomy after natural orifices translumenal endoscopic surgery (NOTES): an ex vivo study. Surg Endosc. 2014;28(4):1342–7.

    Article  PubMed  Google Scholar 

  43. Overcash WT. Natural orifice surgery (NOS) using StomaphyX for repair of gastric leaks after bariatric revisions. Obes Surg. 2008;18:882–5.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Schweitzer M, Steele K, Mitchell M, Okolo P. Transoral endoscopic closure of gastric fistula. Surg Obes Relat Dis. 2009;5:283–4.

    Article  PubMed  Google Scholar 

  45. Mori H, Kobara H, Fujihara S, et al. Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System. Surg Endosc. 2014;28:683–90.

    Article  PubMed  Google Scholar 

  46. Chiu PWY, Phee SJ, Wang Z, et al. Feasibility of full-thickness gastric resection using master and slave transluminal endoscopic robot and closure by OverStitch: a preclinical study. Surg Endosc. 2014;28:319–24.

    Article  PubMed  Google Scholar 

  47. Watson RR, Thompson CC. Applications of a novel endoscopic suturing device in the GI tract. Gastrointest Endosc. 2011;73:AB105.

    Article  Google Scholar 

  48. Francone TD, Saleem A, Read TA, et al. Ultimate fate of the leaking intestinal anastomosis: does leak mean permanent stoma? J Gastrointest Surg. 2010;14(6):987–92.

    Article  PubMed  Google Scholar 

  49. Raval MJ, Schnitzler M, O’Connor BI, Cohen Z, McLeod RS. Improved outcome due to increased experience and individualized management of leaks after ileal pouch-anal anastomosis. Ann Surg. 2007;246(5):763–70.

    Article  PubMed  Google Scholar 

  50. Almeida AB, Faria G, Moreira H, et al. Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery. Int J Surg. 2012;10(2):87–91.

    Article  CAS  PubMed  Google Scholar 

  51. Hyman N, Manchester TL, Osler T, et al. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245(2):254–8.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Abbas MA. Endoscopic management of acute colorectal anastomotic complications with temporary stent. JSLS. 2009;13(3):420–4.

    PubMed Central  PubMed  Google Scholar 

  53. Flicker MS, Lautz DB, Thompson CC. Endoscopic management of gastrogastric fistulae does not increase complications at bariatric revision surgery. J Gastrointest Surg. 2011;15:1736–42.

    Article  PubMed  Google Scholar 

  54. Neto MG, Rodriguez L, Zundel N. Endoscopic revision of Roux-en-Y gastric bypass stomal dilation with a suturing device: preliminary results of a first out-of-United-States series. Bariatric Times. 2011;8:32–4.

    Google Scholar 

  55. Pauli EM, Marks JM. Diagnostic gastro-duodenoscopy via a gastro-gastric fistula prior to OverStitch closure. Surg Endosc. 2012;26:S224–41.

    Article  Google Scholar 

  56. Jirapinyo P, Dayyeh BKA, Slattery J, et al. Endoscopic repair of dilated gastrojejunal anastomoses using a novel endoscopic suturing device. Gastroenterology. 2011;140(5 suppl 1):S118.

    Google Scholar 

  57. Pham BV, Raju GS, Ahmed I, et al. Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device: feasibility and outcome in a porcine model (with video). Gastrointest Endosc. 2006;64:113–9.

    Article  PubMed  Google Scholar 

  58. Pauli EM, Delaney CP, Chanmagne B, Stein S, Marks JM. Safety and effectiveness of an endoscopic suturing device in a human colonic treat-and-resect model. Surg Innov. 2013;20(6):594–9.

    Article  PubMed  Google Scholar 

  59. Kantsevoy SV, Bitner M, Mitrakov AA, Thuluvath PJ. Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). Gastrointest Endosc. 2014;79(3):503–7.

    Article  PubMed  Google Scholar 

  60. Voermans RP, Verqonwe F, Breedveld P, Fockens P, van Berge Heneqonwen MI. Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model. Endoscopy. 2011;43(3):217–22.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. General Surgery, Loyola University Medical Center, Maywood, IL, USA

    Tarek El-Ghazaly M.D.

  2. Minimally Invasive Surgery, Surgery Department, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA

    Pornthep PrathanvanichPrathanvanich M.D., F.R.C.S.T., F.A.C.S.

  3. Department of Surgery/Division of Metabolic Surgery and Bariatric Care, GI/Minimally Invasive Surgery, Loyola University Medical Center, 2160 S. First Ave., 3rd Floor, Room 3224, Maywood, IL, 60153, USA

    Bipan Chand MD, FACS, F.A.S.M.B.S, F.A.S.G.E

Authors
  1. Tarek El-Ghazaly M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pornthep PrathanvanichPrathanvanich M.D., F.R.C.S.T., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bipan Chand MD, FACS, F.A.S.M.B.S, F.A.S.G.E
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Pornthep PrathanvanichPrathanvanich M.D., F.R.C.S.T., F.A.C.S. or Bipan Chand MD, FACS, F.A.S.M.B.S, F.A.S.G.E .

Editor information

Editors and Affiliations

  1. Cleveland Clinic, Section of Surgical Endoscopy, Cleveland, Ohio, USA

    Matthew Kroh

  2. The Oregon Clinic, Division of Gastrointestinal Surgery, Portland, Oregon, USA

    Kevin M. Reavis

Rights and permissions

Reprints and permissions

Copyright information

© 2016 SAGES

About this chapter

Cite this chapter

El-Ghazaly, T., PrathanvanichPrathanvanich, P., Chand, B. (2016). Endoscopic Stent Placement and Suturing: Management of Gastrointestinal Anastomotic Leaks. In: Kroh, M., Reavis, K. (eds) The SAGES Manual Operating Through the Endoscope. Springer, Cham. https://doi.org/10.1007/978-3-319-24145-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-24145-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-24143-2

  • Online ISBN: 978-3-319-24145-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation