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DOI: 10.1055/a-1336-2922
Endoscopic ‘suction room’ to treat complex enteral stump leaks after upper gastrointestinal surgery
Abstract
Leaks/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.
Publication History
Received: 13 August 2020
Accepted: 11 November 2020
Article published online:
19 February 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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