DIGESTIVE NEO-EPITHELIZATION AFTER ENDOSCOPIC STENTING FOR COMPLETE UPPER DIGESTIVE TRACT DISUNION

Aims Complete digestive disunion due to anastomotic leakage is considered as a total contra-indication to endoscopic repair. However, recent publications showed possibility of endoscopic treatment by insertion of SEMS. The aim of this series is to show the possibility of endoscopic management of some selected cases with complete digestive disunion.

Methods Consecutive patients with complete and circumferential upper-GI anastomotic disunion were treated in two European tertiary care centers between 2009 and 2020 by endoscopic insertion of SEMS. Treatment was performed with therapeutic gastroscope under general anesthesia.

Results A total of 7 patients (4males; median age:60, range:49-77) with complete digestive disunion were successfully treated by endoscopy. Three patients (43%) had a malignant disease. First endoscopy was performed after a median of 14 days after the surgery (range:2-30). In 4 patients, a previous surgical or percutaneous drainage was attempted. Three patients (43%) experienced distal migration of SEMS (20% of all placed stents), without precluding the healing. There was no other complication.

All completely healed after a median of 8 weeks (range:4-32) of stenting, needing a median of 3 endoscopic sessions (range:2-6) with a median number of 2 SEMS insertion (range: 1-6) by patient.

Six patients had a median follow-up of 38 months (range:20-120). Among them, three patients (50%) experienced a stricture, all successfully treated by endoscopic dilation (median of 3 sessions; range:2-8). No patient experienced recurrence of leakage.

Conclusions This case series showed that complete digestive rupture could be, in selected cases, successfully treated by endoscopy, adding a proof-of-concept about a guided tissue regeneration alongside SEMS.

Publication History

Article published online:
14 April 2022