Efficacy and safety of endoscopic internal drainage using double pigtail stents for the treatment of postsurgical anastomotic leaks of the upper gastrointestinal tract

Aims The optimal endoscopic treatment of postsurgical leaks (PSL) remained to be determined. Endoscopic internal drainage (EID) using double pigtail stents (DPS) might be an option.

Primary outcome was clinical success. Secondary outcomes included technical success, endoscopic sessions required, time until resolution and adverse events.

Methods Multicenter retrospective case series. Clinical success was defined as endoscopic or radiological confirmation of PSL closure and lack of need for surgery or other endoscopic treatment.

Results 36 patients were included, median age of 65.5 years (IQR 49.7-73.7), 25 patients with malignant and 11 patients with previous bariatric surgery.

PSL occurred after a median of 4 days (IQR 4-14) following the index surgery. Twenty-two PSL had thoracic localization and 14 patients had an abdominal localization. The leak size and collection size were 8 mm (IQR 4-10) and 40 mm (IQR 27-54), respectively. Previous closure with self-expanding metal stent had been attempted in 8 patients (22.2%). During the index procedure, 11 patients (30.6%) were admitted to the ICU. The technical and clinical success rate was achieved in 100% and 77.8%, respectively. The time until clinical success was 23.5 days (IQR: 12.5-53-5). 1.5 endoscopic sessions (IQR 1-3) and insertion of 2 (IQR 1-2) DPS. Following the index procedure, patients were discharged after a median of 27 days (IQR 11-39). Additional endoscopic procedures were required in 13 patients (36.1%): SEMS insertion (n=7), balloon dilation (n=3), and saline lavage (n=3). Additionally, 14 patients required percutaneous drainage and 4 patients required surgical treatment.

No intraprocedural complications were observed. Although long-term complications were identified in 7 patients (19.4%) (stent migration n=4, intraluminal stenosis n=2, and postprocedural hemorrhage n=1).

Conclusions EID using DPT is an effective option for different upper gastrointestinal tract PSL with clinical success in nearly eighty percent.

Publication History

Article published online:
15 April 2024