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DOI: 10.1055/s-0042-121664
Endoscopic treatment of leak at the tip of the “J” ileal pouch
Publication History
submitted
11 August 2016
accepted
after revision
02 November 2016
Publication Date:
25 January 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201701/lookinside/thumbnails/688_10-1055-s-0042-121664-1.jpg)
Abstract
Background and study aims The tip of the “J” of the ileal pouch is the vulnerable location for leak after restorative proctocolectomy, which has normally been treated with surgery. We aimed to describe a novel endoscopic method to treat the same.
Patients and methods A cohort of 12 consecutive patients with a leak at the tip of the “J” was identified in our prospectively maintained Pouch Registry. The endoscopic over-the-scope clipping (OTSC) system was used for the closure of the leak.
Results Eight patients (66.6 %) achieved complete closure of the leak documented by endoscopy confirmed with guidewire and/or contrasted pouchogram, with 6 requiring a single endoscopic session and 2 undergoing a repeat session. Four patients (33.3 %) had a persistent leak and required surgical intervention, of whom 1 developed abscess in the pre-spine region 14 days after the endoscopic procedure and underwent pouch revision surgery.
Conclusions OSTC appears to be safe and effective in treating the leak at the tip of the “J” in the majority of patients.
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References
- 1 Fazio VW, Kiran RP, Remzi FH. et al. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 2013; 257: 679-685
- 2 MacRae HM, McLeod RS, Cohen Z. et al. Risk factors for pelvic pouch failure. Dis Colon Rectum 1997; 40: 257-262
- 3 Kirat HT, Kiran RP, Oncel M. et al. Management of leak from the tip of the "J" in ileal pouch-anal anastomosis. Dis Colon Rectum 2011; 54: 454-459
- 4 Lian L, Shen B. Closure of leak at the tip of the "J" after ileal pouch-anal anastomosis using a novel over-the-scope clipping system. J Coloproctol 2014; 34: 120-123
- 5 Heuschen UA, Allemeyer EH, Hinz U. et al. Outcome after septic complications in J pouch procedures. Br J Surg 2002; 89: 194-200
- 6 Pellino G, Selvaggi F. Outcome of salvage surgery for ileal pouch complication and dysfunction. The experience of a referral Centre and review of literature. J Crohns Colitis 2015; 9: 548-557
- 7 Remzi FH, Fazio VW, Kirat H. et al. Repeat pouch surgery by the abdominal approach safely salvages failed ileal pelvic pouch. Dis Colon Rectum 2009; 52: 198-204
- 8 Wedi E, Gonzalez S, Menke D. et al. One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas. World J Gastroenterol 2016; 22: 1844-1853
- 9 Goenka MK, Goenka U. Endotherapy of leaks and fistula. World J of Gastrointes Endosc 2015; 7: 702-713
- 10 Sanaka MR, Raja S, Thota PN. Esophageal perforation after pneumatic dilation for achalasia: successful closure with an Over-the-Scope clip. J Clinical Gastroenterol 2016; 50: 267-268