Combination Endoscopic Therapy is Effective for Treatment of Nonbariatric Postoperative Gastroenteric Leaks

Abstract

Background and AimsPostoperative leaks of the foregut are associated with significant morbidity and mortality. While there is extensive data on the use of luminal stents for treatment of esophageal and postbariatric leaks, limited data exists regarding endoscopic management of gastroenteric leaks. MethodsOur single-center retrospective cohort study reviewed 31 patients undergoing endoscopic therapy for nonbariatric postoperative gastroenteric foregut leaks between 2011 and 2018. Fifteen patients who received at least one combination endoscopic therapy (CET) procedure involving placement of a FCSEMS as well as local closure using endoscopic suturing or over the scope clip placement were compared to 16 patients who received only single-modality endoscopic therapy. The primary outcome was clinical success (resolution of the leak, removal of percutaneous drains, and avoidance of surgical reoperation). Multivariable log-binomial regression was performed to determine the association between combination therapy and clinical success. ResultsTechnical success was achieved in 100% of patients and clinical success in 61%. CET achieved clinical success in 13 of 15 (87%) patients compared to 6 of 16 (38%) patients in the single-modality endoscopic therapy group (adjusted risk ratio 2.72 95% confidence interval 1.42-5.20, P = 0.002). Stent migration occurred in 18% of patients and required endoscopic retrieval. ConclusionOur case series demonstrates that a majority of nonbariatric gastroenteric leaks resolved with endoscopic therapy. CET was associated with a significantly higher rate of clinical success compared with single modality therapy involving stenting or local closure alone.