Background

Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks.

Methods

All consecutive patients with large (> 10 mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure.

Results

A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15 mm) was diagnosed 6 days (IQR 4–9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7 months (IQR 3.8–20.7), GL closure was observed in 82.7% with a median time of 63 days (IQR 40–90). Surgical management was finally necessary in four patients after a median of 186 days (IQR 122–250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up.

Conclusion

An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL.

中文翻译：

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双辫状引流管穿过覆膜支架内镜治疗胃切除术后大胃漏

背景

内窥镜检查是治疗术后胃漏 (GL) 的金标准。大瘘管与高治疗失败率相关。本研究的目的是评估使用覆盖支架 (CS) 穿过猪尾 (PD) 的联合技术治疗大面积术后 GL 渗漏的临床疗效。

方法

单中心回顾性研究中包括所有连续的大（> 10 毫米）术后 GL 内镜下联合 CS 和 PD 治疗的患者。主要终点是 GL 闭合率。

结果

总共包括 29 名患者。25 名患者接受了袖状胃切除术。瘘管（中位直径 15 mm）在手术后 6 天（IQR 4-9）被诊断出来。在所有程序中都观察到了技术上的成功。在中位随访 10.7 个月（IQR 3.8-20.7）后，82.7% 的患者观察到 GL 闭合，中位时间为 63 天（IQR 40-90）。在中位 186 天 (IQR 122–250) 后，四名患者最终需要手术治疗。随访期间未观察到与联合内镜治疗相关的并发症，尤其是支架移位。

结论

结合 CS 穿过 PD 的内窥镜策略对于治疗大 GL 似乎是有效、安全且耐受性良好的。