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Endoscopic treatment of large gastric leaks after gastrectomy using the combination of double pigtail drains crossing a covered stent

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A Correction to this article was published on 27 December 2022

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Abstract

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.

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Abbreviations

PG :

Pigtail

CS :

Cover stent

GL :

Gastric leak

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Authors and Affiliations

  1. Gastroenterology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France

    Clara Yzet, Sami Hakim, Jean-Phillippe Le Mouel, Constance Deschepper, Richard Delcenserie, Eric Nguyen-Khac, Mathurin Fumery & Franck Brazier

  2. Gastroenterology Unit, Hopital Edouard Herriot, Lyon, France

    Mathieu Pioche & Pierre Lafeuille

  3. Radiology Unit, Amiens University Hospital, Université de Picardie Jules Verne, Amiens, France

    Thierry Yzet

Authors
  1. Clara Yzet
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Contributions

CY, and SH were involved in study concept and design. CY and JPLM contributed to acquisition of data. CY, MF, SH, FB were involved in analysis and interpretation of data. CY was involved in drafting of the manuscript and is Guarantor of the article. CY, SH, JPLM, FB, MF, ENK, MP contributed to critical revision of the manuscript for important intellectual content and approval of the final manuscript.

Corresponding author

Correspondence to Clara Yzet.

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Disclosures

Mathurin Fumery: lecture and consultant fees from Abbvie, Pfizer, MSD, Takeda, Ferring, Janssen, Boehringer, Celgene, Gilead, Galapagos, Biogen, Amgen. Clara Yzet: lecture and consultant fees Abbvie, Takeda, Janssen, Galapagos. Sami Hakim, Mathieu Pioche, Jean-phillippe Le Mouel, Constance Deschepper, Pierre Lafeuille, Richard Delcenserie, Thierry Yzet, Eric Nguyen-Khac and Franck Brazier have no conflicts of interest or financial ties to disclose.

Ethical approval

The protocol was approved by the institutional review board (CNIL committee: Comite Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Sante) No PI2020_843_0155.

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Yzet, C., Hakim, S., Pioche, M. et al. Endoscopic treatment of large gastric leaks after gastrectomy using the combination of double pigtail drains crossing a covered stent. Surg Endosc 36, 9469–9475 (2022). https://doi.org/10.1007/s00464-022-09623-x

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