ENDOSCOPIC MANAGEMENT OF COMPLICATIONS AFTER ESOPHAGECTOMY AND GASTRIC TRASNPOSITION

Aims:

Esophagectomy with gastric transposition or gastric pulled-up is indicated in some cases of esophageal carcinoma, and severe caustic esophagitis. Serious complications include necrosis, torsion, delayed emptying of the gastric tube and leakage of anastomosis. Surgical reoperation is complex (35% mortality for leaks and 90% in necrosis.). Endosocpic management in selected cases could be an alternative.

Methods:

A series of 7 complicated patients managed endoscopically between 2009 and 2015 is presented. In 2 patients with gastric necrosis endoscopic necrosectomy was performed and covered stents were placed for 2 months. Two patients with torsion of the gastric tube were treated with covered stents for 3 months. Two patients with esophagogastric anastomosis leak were treated with partially covered stents for 6 weeks. In one of them the thorax was approached endoscopically by the leak allowing collection drainage and partial pulmonary decortication. In 1 patient with vagal lesion and delayed gastric emptying GPOEM was performed.

Results:

The 2 patients with gastric necrosis developed refractory stenosis after the Stent, managed with dilatation, mitomycin and additional Stents for 9 and 6 months,. The first patient (cardiac carcinoma) remains asymptomatic 3 years after the second stent. The second patients with severe caustic injury presented rupture of the trachea due to erosion of the SEMS and fatal outcome due to sepsis. The 2 patients with twisted gastric conduit were asymptomatic post Stent (follow-up 6 months and 1 year). The rest of the patients evolved satisfactorily.

Conclusions:

In severe Complications post esophagectomy and gastric transposition, endoscopic management is possible. However, devastating adverse events related to endoscopic intervention are not ruled out.