OTSC AND STENTS IN PATIENTS WITH POST-SURGICAL LEAKS INVOLVING THE LOWER GASTROINTESTINAL TRACT: A SINGLE CENTER ANALYSIS OVER A 10 YEAR PERIOD

Aims Post-surgical fistula following gastrointestinal surgery may represent a dreadful event, associated both to high morbidity, mortality and increased health costs. We described a large series of patients with post-surgical leaks involving the lower gastrointestinal tract managed endoscopically.

Methods This was a retrospective analysis of prospectively collected cases .Data have been collected in a single endoscopic tertiary center from January 2010 to June 2019. Interventions included: over-the-scope clip (OTSC) and placement of a partially or fully covered metal stent (SEMS).

Results A total of 58 patients (mean age 61.5±12.8, range 34-92; 35 males) underwent

endoscopic treatment for a perianastomotic leak (dehiscence or fistula) in the lower

gastrointestinal tract. A multidisciplinary approach (radiological, surgical and nutritional support) was scheduled in all cases.

The series included leaks developed after anterior rectal resection (n=14), left colectomy (n=17), sigmoid colectomy (n=5), subtotal colectomy (n=2), right colectomy (n=4), segmental colonic resection (n=6), total colectomy (n=1), ileal resection (n=4), hysteroannessiectomy (n=4) and prostatectomy (n=1). A laparoscopic surgical approach was performed in 28 (48,3%) patients. The intestinal leak was classified as early in 20 (34.5%) cases and delayed in 38 (65.5%) patients. Despite a technical success obtained in 56 cases (96,6%), a long term clinical success was observed in 37 (64%) patients. Overall, leak closure failed in 21 (36%) patients, managed surgically. Major endoscopic procedure complications were two colonic perforations in patient treated with SEMS.

Regarding the clinical success rate no statistically significant differences were found between patients treated with a single or multiple devices (p=0.99) and between patients with an early or delayed leak (63.8% vs 61.1%; p=0.73).

Conclusions Both stents and OTSC have revolutionized the management of patients with lower anastomotic leaks establishing a less expensive and invasive alternative treatment.