Endoscopic ‘suction room’ to treat complex enteral stump leaks after upper gastrointestinal surgery

Author:

Mutignani Massimiliano1,Dioscoridi Lorenzo1,Venezia Ludovica2,Larghi Alberto34,Pugliese Francesco1,Cintolo Marcello1,Bonato Giulia1,Forti Edoardo1

Affiliation:

1. Digestive Endoscopy Unit, ASST Niguarda, Milan, Italy

2. Gastroenterology Unit, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

3. Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, Rome, Italy

4. CERTT, Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy

Abstract

AbstractLeaks/dehiscence of the enteral stump associated with infected peri-enteric collections after upper gastrointestinal surgery are a life-threatening adverse event, not usually endoscopically treatable.We describe a new endoscopic approach to treat complex entero-cutaneous fistulas (CECF) by creating a “suction room” through placement of multiple stents (enteral, biliary and/or pancreatic) and a large nose-enteral suction tube inside the enteral stent maintained on a continuous negative aspiration suction.Between January 2016 and December 2019, six consecutive patients referred to our unit with CECF of the enteral stump after failed redo surgeries underwent creation of a “suction room.” In five patients, enteral, biliary and pancreatic stents were positioned before a nose-to-stent or nose-to-collection large 18 Fr tube placement. In one patient, a pancreatic stent was not placed. Technical and clinical success were achieved in all patients. Mean and median times of aspiration were 49 and 27 days, respectively, with a mean hospital stay of 56 days after the endoscopic procedure. Stents were successfully removed. Mean post-procedural follow-up was 17.3 months.Endoscopic creation of the “suction room” offers the unique possibility of treating complex entero-cutaneous fistulas in surgically altered sites, which are difficult to manage with standard endoscopic methods.

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology,Medicine (miscellaneous)

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