Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?

Abstract

Background/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods: From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results: Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining ten patients, nine (90%) did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the first week and a soft diet in the second week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions: Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Endoscopic Internal Drainage Achieving Successful Closure of Iatrogenic Pharyngoesophageal Fistula

“… 11 In their case series, Toh et al reported successful closure of anastomotic defects using EID in 9 of 12 patients with upper GI fistulas. 12 However, we were not able to find any reports published in the literature where the EID method was used in the closure of an oropharyngeal defect as in our case. To the best of our knowledge, this is the first reported case of repair of an oropharyngeal fistula using the EID technique.…”

Endoscopic Intervention for Anastomotic Leakage After Gastrectomy

“…One advantage of EID is that it enables early enteral feeding. In a retrospective analysis conducted on patients who had a double pigtail tube inserted for internal drainage of an anastomotic leak after upper GI surgery in 2 tertiary upper GI centers, the findings revealed that majority of patients were permitted oral fluids within 1 week and a soft diet in the second week [ 27 ]. Providing early nutritional support and effectively managing sepsis through drainage are crucial components of treatment of anastomotic leakage.…”

“…Providing early nutritional support and effectively managing sepsis through drainage are crucial components of treatment of anastomotic leakage. Endoscopic internal drainage can improve patient mobility and potentially shorten hospital stay, reducing the risk of complications, such as deep vein thrombosis and hospital-acquired pneumonia that can result from extended hospitalization [ 27 ]. The incidence of adverse events associated with EID typically falls within the range of 4%–15%, with most cases amenable to conservative management.…”

Endoscopic Management of Post-Sleeve Gastrectomy Complications

“…The mean treatment duration for EID was 78.4 days [40]. EID is generally better tolerated than CSEMS and allows for the early resumption of an oral diet [41,42]. EID also does not expose patients to the risks associated with reoperation or percutaneous drainage (i.e., gastrocutaneous fistula) [43].…”