Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review
Abstract
:1. Introduction
2. Endoscopic Techniques
2.1. Stenting
2.2. Endoscopic Clip Placement (TTSC and OTSC)
2.3. Endoscopic Suturing
2.4. Endoscopic Vacuum Therapy (EVT)
Timing of EVT after Upper GI Surgery
2.5. Endoscopic Internal Drainage (EID)
3. New Concepts
4. Treatment Logarithm Proposal
5. Discussion
6. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BDS | biodegradable stent |
CBS | customized bariatric stents |
CES | conventional esophageal stents |
EID | endoscopic internal drainage |
EVT | endoscopic vacuum therapy |
ESGE | European Society of Gastrointestinal Endoscopy |
FCSEMS | fully covered self-expandable metallic stents |
OTSC | over the scope clip |
PCSEMSs | partially covered self-expandable metallic stents |
SEMS | self-expandable metal stent |
SEPS | self-expandable plastic stents |
SOS | stent over sponge |
TTSC | through the scope clip |
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Device | Main Indication | Pros | Cons | AEs | |
---|---|---|---|---|---|
STENT | SEPS FCSEMS PCSEMS BDs | Leaks Fistula Perforation > 2 cm | Easy placement High technical and clinical success Avoid stenosis Combined approach with clips | Expensive High migration rate Possible multiple sessions Need of percutaneous drainage of collection | Migration Food impaction Mucosal erosions Bleeding Perforation Stent ruptures Drooling, foreign body sensation |
CLIP | TTSc | Leaks or perforations < 1 cm Acute perforations | Large availability Different shapes and sizes available Integration with other techniques | Limited efficacy Need of multiple interventions No full-thickness closure Need of percutaneous drainage of collection | Failure Migration |
OTSc | Leaks or perforations up to 2–3 cm Acute and chronic perforations | Full-thickness closure Single-step procedure | Need of percutaneous drainage of collection | Misdeployment | |
ENDOSUTURING | Overstitch Overstitch SX | Early defects > 2 cm | Full thickness closure High clinical and technical success | Expensive Need of high expertise Challenging use in angulated GI regions Need of percutaneous drainage of collection | Bleeding Strictures |
ENDOSCOPIC VACUUM THERAPY (EVT) | Esosponge Suprasorb | Leaks, fistula, perforation with associated cavity | High clinical and technical success rate Simultaneous drainage of collection | Patient discomfort due to external tube drainage Need of multiple sessions | Bleeding Sponge ingrowth Strictures |
ENDOSCOPIC INTERNAL DRAINAGE (EID) | Perforation and leaks with associated cavity | High clinical and technical success rate Low cost Oral feeding feasible | Need odultiple session | Bleeding Migration Splenic Hematoma |
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Binda, C.; Jung, C.F.M.; Fabbri, S.; Giuffrida, P.; Sbrancia, M.; Coluccio, C.; Gibiino, G.; Fabbri, C. Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review. Medicina 2023, 59, 136. https://doi.org/10.3390/medicina59010136
Binda C, Jung CFM, Fabbri S, Giuffrida P, Sbrancia M, Coluccio C, Gibiino G, Fabbri C. Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review. Medicina. 2023; 59(1):136. https://doi.org/10.3390/medicina59010136
Chicago/Turabian StyleBinda, Cecilia, Carlo Felix Maria Jung, Stefano Fabbri, Paolo Giuffrida, Monica Sbrancia, Chiara Coluccio, Giulia Gibiino, and Carlo Fabbri. 2023. "Endoscopic Management of Postoperative Esophageal and Upper GI Defects—A Narrative Review" Medicina 59, no. 1: 136. https://doi.org/10.3390/medicina59010136