Digestive Disease Interventions 2018; 02(04): 346-358
DOI: 10.1055/s-0038-1675412
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Endoscopic Management of Gastrointestinal Complications

Samantha R. Witte
1   Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Eric M. Pauli
1   Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
› Author Affiliations
Further Information

Publication History

20 September 2018

26 September 2018

Publication Date:
20 November 2018 (online)

Abstract

Despite improvements in preoperative patient optimization, refinements in surgical methodology and technology, and the implementation of enhanced recovery protocols, complications following gastrointestinal (GI) surgery remain a fact of life. As the rates of GI surgical procedures increase worldwide, so will the volume of complications. The surgical management of complications is often not ideal, as some (such as acute staple line bleeding or the development of an anastomotic stricture) are luminal-based processes that are difficult to approach from an extraluminal (i.e., surgical) perspective. Endoscopy has largely replaced surgery for the management of such postoperative problems. Leak, the most feared complications of GI surgery, can result from intestinal resection, anastomosis formation, or from iatrogenic injury. With advancements in both diagnostic and therapeutic endoscopy, novel endoluminal and transluminal management options for leak continue to evolve. In centers where these interventions are readily available, they are becoming a first-line treatment option. This article will review the endoscopic management of GI complications with a particular focus on the management of postoperative strictures and of full-thickness GI tract defects (perforations, acute leaks, and chronic fistulae).

 
  • References

  • 1 Prevention, C.f.D.C.a., National Hospital Discharge Survey: 2010 Table, Procedures by selected patient characteristics.
  • 2 Rinaldi S, Lise M, Clavel-Chapelon F. , et al. Body size and risk of differentiated thyroid carcinomas: findings from the EPIC study. Int J Cancer 2012; 131 (06) E1004-E1014
  • 3 Hanyu T, Kosugi S, Ishikawa T, Ichikawa H, Wakai T. Incidence and risk factors for anastomotic stricture after esophagectomy with gastric tube reconstruction. Hepatogastroenterology 2015; 62 (140) 892-897
  • 4 Go MR, Muscarella II P, Needleman BJ, Cook CH, Melvin WS. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass. Surg Endosc 2004; 18 (01) 56-59
  • 5 Blackstone RP, Rivera LA. Predicting stricture in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass: a logistic regression analysis. J Gastrointest Surg 2007; 11 (04) 403-409
  • 6 Luchtefeld MA, Milsom JW, Senagore A, Surrell JA, Mazier WP. Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership. Dis Colon Rectum 1989; 32 (09) 733-736
  • 7 Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E. Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 2001; 44 (10) 1464-1468
  • 8 Legnani PE, Kornbluth A. Therapeutic options in the management of strictures in Crohn's disease. Gastrointest Endosc Clin N Am 2002; 12 (03) 589-603
  • 9 Blomberg B, Rolny P, Järnerot G. Endoscopic treatment of anastomotic strictures in Crohn's disease. Endoscopy 1991; 23 (04) 195-198
  • 10 Pereira-Lima JC, Ramires RP, Zamin Jr I, Cassal AP, Marroni CA, Mattos AA. Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol 1999; 94 (06) 1497-1501
  • 11 Kozarek RA, Patterson DJ, Ball TJ. , et al. Esophageal dilation can be done safely using selective fluoroscopy and single dilating sessions. J Clin Gastroenterol 1995; 20 (03) 184-188
  • 12 Wang YG, Tio TL, Soehendra N. Endoscopic dilation of esophageal stricture without fluoroscopy is safe and effective. World J Gastroenterol 2002; 8 (04) 766-768
  • 13 Lucha Jr PA, Fticsar JE, Francis MJ. The strictured anastomosis: successful treatment by corticosteroid injections--report of three cases and review of the literature. Dis Colon Rectum 2005; 48 (04) 862-865
  • 14 Brooker JC, Beckett CG, Saunders BP, Benson MJ. Long-acting steroid injection after endoscopic dilation of anastomotic Crohn's strictures may improve the outcome: a retrospective case series. Endoscopy 2003; 35 (04) 333-337
  • 15 Kochhar R, Poornachandra KS. Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc 2010; 2 (02) 61-68
  • 16 Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilation. J Clin Gastroenterol 2002; 35 (02) 117-126
  • 17 Mendelson AH, Small AJ, Agarwalla A, Scott FI, Kochman ML. Esophageal anastomotic strictures: outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal. Clin Gastroenterol Hepatol 2015; 13 (02) 263-271.e1
  • 18 Samanta J, Dhaka N, Sinha SK, Kochhar R. Endoscopic incisional therapy for benign esophageal strictures: technique and results. World J Gastrointest Endosc 2015; 7 (19) 1318-1326
  • 19 Avcioglu U, Ölmez Ş, Pürnak T, Özaslan E, Altıparmak E. Evaluation of efficacy of endoscopic incision method in postoperative benign anastomotic strictures of gastrointestinal system. Arch Med Sci 2015; 11 (05) 970-977
  • 20 Repici A, Hassan C, Sharma P, Conio M, Siersema P. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther 2010; 31 (12) 1268-1275
  • 21 Bazerbachi F, Heffley JD, Abu Dayyeh BK. , et al. Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study. Endosc Int Open 2017; 5 (09) E861-E867
  • 22 Pauli EM. Endoscopic tools and techniques for strictures and stenoses. In: Marks JM. , ed. Principles of Flexible Endoscopy for Surgeons. New York, NY: Springer; 2013: 105-118
  • 23 Winder JS, Pauli EM. Comprehensive management of full-thickness luminal defects: the next frontier of gastrointestinal endoscopy. World J Gastrointest Endosc 2015; 7 (08) 758-768
  • 24 Geraci G, Pisello F, Modica G, Li Volsi F, Arnone E, Sciumè C. Complications of elective esophago-gastro-duodenoscopy (EGDS). Personal experience and literature review [in Italian]. G Chir 2009; 30 (11-12): 502-506
  • 25 Merchea A, Cullinane DC, Sawyer MD. , et al. Esophagogastroduodenoscopy-associated gastrointestinal perforations: a single-center experience. Surgery 2010; 148 (04) 876-880 , discussion 881–882
  • 26 Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 2009; 41 (11) 941-951
  • 27 Rutegård M, Lagergren P, Rouvelas I, Lagergren J. Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol 2012; 19 (01) 99-103
  • 28 Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004; 10 (02) 71-75
  • 29 Sauvanet A, Mariette C, Thomas P. , et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 2005; 201 (02) 253-262
  • 30 Juza RM, Haluck RS, Pauli EM, Rogers AM, Won EJ, LynSue JR. Gastric sleeve leak: a single institution's experience with early combined laparoendoscopic management. Surg Obes Relat Dis 2015; 11 (01) 60-64
  • 31 Sakran N, Goitein D, Raziel A. , et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 2013; 27 (01) 240-245
  • 32 Morales MP, Miedema BW, Scott JS, de la Torre RA. Management of postsurgical leaks in the bariatric patient. Gastrointest Endosc Clin N Am 2011; 21 (02) 295-304
  • 33 McElrath L, Pauli EM, Marks JM. Hernia formation and persistent fistula after percutaneous endoscopy gastrostomy: unusual complications of a common procedure. Am Surg 2012; 78 (04) E200-E201
  • 34 Del Gaizo AJ, Lall C, Allen BC, Leyendecker JR. From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography. Abdom Imaging 2014; 39 (04) 802-823
  • 35 Juza RM. , et al. Transluminal Endoscopic Drain Repositioning for Post-operative Gastrointestinal Leaks: A Case Series. In 16th World Congress of Endoscopic Surgery; 2018 . Seattle, WA
  • 36 Juza RM, Fitzgerald K, Pauli EM. Transluminal Endoscopic Drain Repositioning for Post-Operative Gastrointestinal Leaks. A Practical NOTES Applications. In 16th World Congress of Endoscopic Surgery; 2018 . Seattle, WA
  • 37 Binmoeller KF, Grimm H, Soehendra N. Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma. Gastrointest Endosc 1993; 39 (02) 172-174
  • 38 Yoshikane H, Hidano H, Sakakibara A. , et al. Endoscopic repair by clipping of iatrogenic colonic perforation. Gastrointest Endosc 1997; 46 (05) 464-466
  • 39 Orenstein SB, Raigani S, Wu YV. , et al. Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy. Surg Endosc 2015; 29 (05) 1064-1070
  • 40 Ponsky JL, Marks JM, Pauli EM. How I do it: per-oral endoscopic myotomy (POEM). J Gastrointest Surg 2012; 16 (06) 1251-1255
  • 41 Magdeburg R, Collet P, Post S, Kaehler G. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 2008; 22 (06) 1500-1504
  • 42 Cho SB, Lee WS, Joo YE. , et al. Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc 2012; 26 (02) 473-479
  • 43 Al Ghossaini N, Lucidarme D, Bulois P. Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Dig Liver Dis 2014; 46 (03) 195-203
  • 44 Kapadia S, Nagula S, Kumta NA. Argon plasma coagulation for successful fragmentation and removal of an over-the-scope clip. Dig Endosc 2017; 29 (07) 820-821
  • 45 Schmidt A, Riecken B, Damm M, Cahyadi O, Bauder M, Caca K. Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 2014; 46 (09) 762-766
  • 46 Raithel M, Albrecht H, Scheppach W. , et al. Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients. Surg Endosc 2017; 31 (06) 2411-2425
  • 47 Winder JS, Kulaylat AN, Schubart JR, Hal HM, Pauli EM. Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience. Surg Endosc 2016; 30 (06) 2251-2258
  • 48 Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E, Dabrowski A. Endoscopic management of gastrointestinal perforations, leaks and fistulas. World J Gastroenterol 2015; 21 (37) 10542-10552
  • 49 Law R, Wong Kee Song LM, Irani S, Baron TH. Immediate technical and delayed clinical outcome of fistula closure using an over-the-scope clip device. Surg Endosc 2015; 29 (07) 1781-1786
  • 50 Pauli EM, Delaney CP, Champagne B, Stein S, Marks JM. Safety and effectiveness of an endoscopic suturing device in a human colonic treat-and-resect model. Surg Innov 2013; 20 (06) 594-599
  • 51 Kantsevoy SV, Thuluvath PJ. Successful closure of a chronic refractory gastrocutaneous fistula with a new endoscopic suturing device (with video). Gastrointest Endosc 2012; 75 (03) 688-690
  • 52 Strong AT, Allemang MT, Alli V. , et al. Results of the Ovesco-Over-Overstitch Technique for Managing Bariatric Surgical Complications. In 16th World Congress of Endoscopic Surgery; 2018 . Seattle, WA
  • 53 van den Berg MW, Kerbert AC, van Soest EJ. , et al. Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula. Dis Esophagus 2016; 29 (06) 572-579
  • 54 Simon F, Siciliano I, Gillet A, Castel B, Coffin B, Msika S. Gastric leak after laparoscopic sleeve gastrectomy: early covered self-expandable stent reduces healing time. Obes Surg 2013; 23 (05) 687-692
  • 55 Southwell T, Lim TH, Ogra R. Endoscopic therapy for treatment of staple line leaks post-laparoscopic sleeve gastrectomy (LSG): experience from a large bariatric surgery centre in New Zealand. Obes Surg 2016; 26 (06) 1155-1162
  • 56 Pauli EM, Schomisch SJ, Blatnik JA, Krpata DM, Sanabria JS, Marks JM. A novel over-the-scope deployment method for enteral stent placement. Surg Endosc 2013; 27 (04) 1410-1411
  • 57 Pauli EM, Marks JM. Endoscopic tools and techniques for strictures and stenoses. In: Marks JM. , ed. Principles of Flexible Endoscopy for Surgeons. New York, NY: Springer; 2013: 105-118
  • 58 Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008; 22 (08) 1818-1825
  • 59 Pournaras DJ, Hardwick RH, Safranek PM. , et al. Endoluminal vacuum therapy (E-VAC): a treatment option in oesophagogastric surgery. World J Surg 2018; 42 (08) 2507-2511
  • 60 Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-VAC) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc 2016; 30 (06) 2473-2480
  • 61 Bludau M, Fuchs HF, Herbold T. , et al. Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks. Surg Endosc 2018; 32 (04) 1906-1914
  • 62 Bludau M, Hölscher AH, Herbold T. , et al. Management of upper intestinal leaks using an endoscopic vacuum-assisted closure system (E-VAC). Surg Endosc 2014; 28 (03) 896-901
  • 63 Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-VAC) therapy. Surg Obes Relat Dis 2016; 12 (07) 1278-1285
  • 64 Ansaloni L, Cambrini P, Catena F. , et al. Immune response to small intestinal submucosa (surgisis) implant in humans: preliminary observations. J Invest Surg 2007; 20 (04) 237-241
  • 65 Maluf-Filho F, Hondo F, Halwan B, de Lima MS, Giordano-Nappi JH, Sakai P. Endoscopic treatment of Roux-en-Y gastric bypass-related gastrocutaneous fistulas using a novel biomaterial. Surg Endosc 2009; 23 (07) 1541-1545
  • 66 Filgate R, Thomas A, Ballal M. Treatment of foregut fistula with biologic plugs. Surg Endosc 2015; 29 (07) 2006-2012
  • 67 Rábago LR, Ventosa N, Castro JL, Marco J, Herrera N, Gea F. Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue. Endoscopy 2002; 34 (08) 632-638
  • 68 Assenza M, Rossi D, De Gruttola I, Ballanti C. Enterocutaneous fistula treatment: case report and review of the literature. G Chir 2018; 39 (03) 143-151