The Role of Endoscopic Treatments in Early and Late Anastomotic Complications After Gastric Surgery: A Systematic Review

Maryam Namazova, MSc. Queen Mary University of London, Barts and The London School of Medicine and Dentistry

Introduction: Early and late anastomotic complications after gastric surgery increase postoperative morbidity, mortality and duration of hospital stay. The endoscopic treatment of anastomotic complications is an alternative way to reoperation.  The aim of this study is to evaluate the safety and efficacy of endoscopic treatments in early and late anastomotic complications after gastric surgery.

Methods: The PubMed, EMBASE, Web of Science and Google Scholar databases were used to find the articles related to this study. In total 18 articles were selected covering period from 1994 to 2014. The success rate of endoscopic treatments in early and late anastomotic complications were calculated and reported.

Results: The study is based on the 342 patients (121 patients for early and 221 patients for late anastomotic complications) who had anastomotic complications after gastric surgery and received different endoscopic treatments (stent placement, balloon dilatation, endoclips, fibrin glue and vacuum therapy). The success rate of endoscopic treatment for early complications is 88% (106 patients out of 121), for late is 97% (214 out of 221) and total is 94% (320 patients out of 342). Stent migration for early complications occurred in 29 patients out of 110 (26%) and for late complications occurred in 7 patients out of 21 (33%). Complication rate of balloon dilatation occurred in 4% of patients (8 patients out of 200).

Conclusions: The results of the study confirmed that endoscopic treatment in early and late postoperative anastomotic complications after gastric surgery is very successful alternative way of treatment to re-operations. It has high rate of success, however there is a risk of after treatment complications such as stent migrations and perforations.