Komdej Thanavachirasin, MD, Eric Marcotte, Assistant, Professor, Pornthep Prathanvanich, MD, Bipan Chand, Associate, Professor. Loyola Hospital Medical Center
Minimally invasive department, Loyola University Medical Center. Illinois,USA
Background: The management of obstruction and leaks has been revolutionized by standard and newer endoscopic modalities. We retrospectively reviewed our prospective database of patients requiring complex endoscopic therapies Technical success as well as overall clinical improvement were carefully studied and reported.
Method: We performed a retrospective review of our Endoscopic database to identify patients having had foregut surgery that subsequently were diagnosed and treated for leaks or obstructions at our quaternary referral center. Data collected and analyzed included demographics, type of surgery, type of complications, endoscopic modality used, and overall technical and clinical success.
Result: From January 2012 to July 2016, 28 patients (14 males, Mean age 53.21+12.22, Mean BMI 29.13+8.28) met the criteria for this study. 13 patients had undergone bariatric surgery, 11 patients had upper gastrointestinal (UGI) cancer surgery, and 4 patients had other benign esophageal, gastric or duodenal operations. The diagnosis of leak was found in 19 patients and obstruction in 15. 13 patients had leaks alone. 11 patients had only obstruction and 4 patients had both a leak and obstruction.
The mean time to diagnosis of the complication was 37.3+52.18 days (0-229) from index surgery. Time to first endoscopic treatment was 10.5+20.86 days (0-50) after the complication was diagnosed. Treatment modalities varied but often included various types of stents. Forty-five stents and catheters were used; 40 self-expanding metal (stents SEMS), 2 salivary bypass stents, and 3 double pigtail catheters. Of the SEMS, the majority of SEMS were partially covered (74.4%). Stent complications occurred in 3 cases and included 1 migration, 1 malposition and one disruption of the covering of the stent. Each complication was successfully addressed endoscopically. All stents were subsequently removed without complication. Clinical endoscopic success was demonstrated in 22/26 (84.6%) patients. Average duration of endoscopic therapy was 45.34+26.02 days. The mean number of sessions was 3.46+1.9. Two patients required revision surgery. Two patients died with unrelated endoscopic therapies and secondary to nature of disease.
Conclusion: Endoscopic salvage therapy for obstruction and leaks following benign and malignant foregut surgery are highly successful and definitive when properly selected. Multi-modal and escalating endoscopic therapy is crucial to success and surgical intervention rarely may be required.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78805
Program Number: P339
Presentation Session: Poster (Non CME)
Presentation Type: Poster