• Acquired airway fistula
• Airway stenting
• Esophageal stenting
• Malignant fistula
• Surgical TEF repair
• Tracheoesophageal fistula

• Humans
• Tracheoesophageal Fistula/surgery
• Stents

• Classification
• Esophageal surgery
• Esophagus
• Perforation

• Humans
• Esophageal Perforation/diagnosis
• Esophageal Perforation/etiology
• Esophageal Perforation/diagnostic imaging
• Male
• Female
• Middle Aged
• Aged
• Adult
• Aged, 80 and over
• Adolescent
• Retrospective Studies
• Young Adult

• Universitätsklinikum Düsseldorf. Anstalt öffentlichen Rechts (8911)

• Caustics
• Corrosive strictures
• Esophageal injury
• Esophageal strictures

Anastomotic leakage (AL) in colorectal resection and primary anastomosis is a common and feared complication. Fully covered self‐expandable metal stents (FCSEMSs) have been used for the treatment of AL. It is still unknown whether FCSEMSs affect anastomosis healing negatively by causing ischemia. In an animal study, we investigated the metabolic effects over a FCSEMS covering a stapled colon anastomosis.

Seven pigs were investigated using microdialysis after laparotomy, colon resection, and anastomosis with stent placement. Measurements were done at the proximal and distal ends of the anastomosis and at a reference catheter placed at the small intestine. Measurements of glucose, pyruvate, lactate, glycerol, and the lactate/pyruvate ratio (L/P) were carried out.

Lactate and L/P were significantly higher at the oral part of the anastomosis, while glucose showed a small declining tendency. At the distal part of the anastomosis, glucose decreased significantly after the resection but did not reach zero. Lactate increased significantly whereas L/P increased only slightly. Glycerol levels were stable.

Colon resection caused initially hypermetabolism in the intestinal ends next to the resection site. This hypermetabolism neither deteriorated nor turned into ischemia during the initial postoperative course, but the start of hypoxemia could not be excluded during the study and after the placement of an FCSEMS.

• anastomotic leak
• fistula
• gastrointestinal perforation
• wound closure technique

Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients.

For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management.

The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential.

The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study.

Trial registration: Not applicable.

• Esophageal perforation
• Esophageal rupture
• Fish bone
• Retrospective

• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Bariatric Surgery/adverse effects
• Gastrectomy/adverse effects
• Humans
• Laparoscopy
• Obesity, Morbid/surgery
• Reoperation
• Retrospective Studies
• Stents
• Treatment Outcome

• GI-stents
• gastrointestinal surgery
• metabolic disorders

• Fistulojejunostomy
• Obesity
• Roux-en-Y gastrojejunostomy
• Sleeve gastrectomy
• Staple line leak

• Anastomosis, Roux-en-Y
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Gastrectomy/adverse effects
• Humans
• Laparoscopy
• Obesity, Morbid/surgery
• Retrospective Studies
• Treatment Outcome

• Esophageal cancer
• Esophageal stent
• Esophagectomy
• Plastic reconstructive surgery
• Tracheal stent

• Bronchial Fistula/diagnosis
• Bronchial Fistula/surgery
• Esophageal Fistula/diagnosis
• Esophageal Fistula/surgery
• Esophageal Neoplasms/surgery
• Humans
• Tracheoesophageal Fistula/diagnosis
• Tracheoesophageal Fistula/surgery

• Anastomotic Leak/therapy
• Esophageal Perforation/therapy
• Esophagus/surgery
• Humans
• Metals
• Plastics
• Stents/adverse effects

Perforated peptic ulcer is a life-threatening condition. Traditional treatment is surgery. Esophageal perforations and anastomotic leakages can be treated with endoscopically placed covered stents and drainage. We have treated selected patients with a perforated duodenal ulcer with a partially covered stent. The aim of this study was to compare surgery with stent treatment for perforated duodenal ulcers in a multicenter randomized controlled trial.

All patients presenting at the ER with abdominal pain, clinical signs of an upper G-I perforation, and free air on CT were approached for inclusion and randomized between surgical closure and stent treatment. Age, ASA score, operation time, complications, and hospital stay were recorded. Laparoscopy was performed in all patients to establish diagnosis. Surgical closure was performed using open or laparoscopic techniques. For stent treatment, a per-operative gastroscopy was performed and a partially covered stent was placed through the scope. Abdominal lavage was performed in all patients, and a drain was placed. All patients received antibiotics and intravenous PPI. Stents were endoscopically removed after 2–3 weeks. Complications were recorded and classified according to Clavien-Dindo (C-D).

43 patients were included, 28 had a verified perforated duodenal ulcer, 15 were randomized to surgery, and 13 to stent. Median age was 77.5 years (23–91) with no difference between groups. ASA score was unevenly distributed between the groups (p = 0.069). Operation time was significantly shorter in the stent group, 68 min (48–107) versus 92 min (68–154) (p = 0.001). Stents were removed after a median of 21 days (11–37 days) without complications. Six patients in the surgical group had a complication and seven patients in the stent group (C-D 2–5) (n.s.).

Stent treatment together with laparoscopic lavage and drainage offers a safe alternative to traditional surgical closure in perforated duodenal ulcer. A larger sample size would be necessary to show non-inferiority regarding stent treatment.

• Duodenal stent
• Peptic ulcer perforation
• Perforated duodenal ulcer

Endoscopic techniques have become the first-line therapy in bariatric surgery-related complications such as leaks and fistulas. We performed a systematic review and meta-analysis on the effectiveness of self-expandable stents, clipping, and tissue sealants in closing of post-bariatric surgery leak/fistula.

A systematic literature search of the Medline/Scopus databases was performed to identify full-text articles published up to February 2019 on the use of self-expandable stents, clipping, or tissue sealants as primary endoscopic strategies used for leak/fistula closure. Meta-analysis of studies reporting stents was performed with the PRISMA guidelines.

Data concerning the efficacy of self-expanding stents in the treatment of leaks/fistulas after bariatric surgery were extracted from 40 studies (493 patients). The overall proportion of successful leak/fistula closure was 92% (95% CI, 90–95%). The overall proportion of stent migration was 23% (95% CI, 19–28%). Seventeen papers (98 patients) reported the use of clipping: the over-the-scope clips (OTSC) system was used in 85 patients with a successful closure rate of 67.1% and a few complications (migration, stenosis, tear). The successful fistula/leak closure using other than OTSC types was achieved in 69.2% of patients. In 10 case series (63 patients), fibrin glue alone was used with a 92.8–100% success rate of fistula closure that usually required repeated sessions at scheduled intervals. The complications of fibrin glue applications were reported in only one study and included pain and fever in 12.5% of patients.

Endoscopic techniques are effective for management of post-bariatric leaks and fistulas in properly selected patients.

The online version of this article (10.1007/s00464-020-07471-1) contains supplementary material, which is available to authorized users.

• Bariatric
• Endoscopic
• Fistula
• Gastric bypass
• Leak
• Sleeve

Upper gastrointestinal perforations, leaks and fistulae are relatively common occurrences with a growing number of these complications occuring as a result of therapeutic advancement and adoption of newer and bolder endoscopic therapies. Historically, these were predominantly managed surgically; however, owing to high morbidity and mortality associated with surgical repair, endoscopic options are preferable. Over the past decade, vast expansion in the endoscopic armamentarium for the management of perforations, leaks and fistulae has led to endoscopic management now being the first-line treatment. Here, we will review the endoscopic modalities including through-the-scope clips, over-the-scope clips, stents, vacuum therapy, endoscopic sutures and sealants. In addition, we will discuss nonendoscopic approach to management including early recognition of perforations, ways to reduce septic complications and format algorithms to guide therapy for different scenarios. However, it is important to stress that there is a lack of high-quality randomised studies to clearly guide management of such complications, resulting in a wide variation of approaches in management by specialists. Each case requires some degree of individualisation due to the potential array of problems encountered and patient-specific co-morbidities. In the future, more robust studies are clearly required to better guide specialist management.

• acute perforation
• endoscopic management
• endoscopy vacuum therapy
• leaks and fistulae
• over-the-scope clips
• stents

• Bronchial fistula
• Esophageal fistula
• Intubation
• Postoperative complications
• Tracheoesophageal fistula
• Treatment outcome
• intratracheal

• Anastomotic leakage
• Bariatric surgery
• Endoscopic stent
• Gastric bypass
• SEMS
• Sleeve gastrectomy

• Complications
• Fistulography
• Gastrocutaneous fistula
• Glue treatment
• Leak
• Management
• Morbid obesity
• Obesity surgery
• Radiology
• Sleeve gastrectomy
• n-Butyl-2-cyanoacrylate

Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.

This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.

A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.

The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

• Fistula
• Gastrointestinal leak
• Over the scope clip
• Perforation

• Airway
• Neoadjuvant induction therapy
• Oesophageal surgery
• Tracheal surgery
• Tracheo-oesophageal fistula

• Postintubation tracheoesophageal fistula
• Surgical treatment
• Tracheoesophageal fistula

Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

• Bariatric surgery
• Bariatric complications
• Endoscopic treatment
• Leaks
• Stenosis
• Sleeve gastrectomy
• Gastric Roux-en-Y bypass

• Clips
• Esophageal stent
• Fistula
• Gastric bypass
• Gastric leak
• Leak
• Oesophageal stent
• Over-the-scope clips
• Sleeve gastrectomy
• Stent
• Surgical obesity complications

• Adult
• Aged
• Bariatric Surgery/adverse effects
• Endoscopy/methods
• Female
• Fistula/etiology
• Fistula/surgery
• Humans
• Male
• Middle Aged
• Obesity, Morbid/surgery
• Retrospective Studies
• Stents
• Surgical Instruments
• Treatment Outcome

• Complications
• endoscopic
• fistula
• laparoscopic sleeve gastrectomy
• leak
• management
• stent

• acellular dermal matrix
• aortic homograft
• bioprosthetic
• large airway defects

• Acellular Dermis
• Allografts
• Aorta/transplantation
• Bioprosthesis
• Bronchial Fistula/etiology
• Bronchial Fistula/surgery
• Bronchoscopy
• Debridement
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stents
• Surgical Flaps
• Tracheoesophageal Fistula/etiology
• Tracheoesophageal Fistula/surgery
• Treatment Outcome

• anastomotic leak
• fistula
• perforation
• stent
• temporary

In Ivor Lewis operation, anastomosis site leakage is a critical complication. Interventional approach utilizing covered metal stent has been introduced for the management of this complication. This patient was diagnosed as esophageal cancer and underwent robot-assisted Ivor Lewis operation. Due to symptoms suggesting anastomosis site leakage, video-assisted thoracoscopic surgery exploration was performed without identification of gross leakage site. On esophagogastroduodenoscopy, anastomosis site leakage was detected and esophageal stent was placed. Four weeks later, the stent was removed, and the patient could intake all his diet orally without discomfort. Esophageal stent insertion can be an option to manage postesophagectomy leakage problem.

• Anastomotic Leak
• Esophageal Neoplasms
• Esophagectomy
• Postoperative Complications
• Stents

• Bariatric surgery
• Endoscopic surgery
• Foregut surgery
• Postoperative complications
• Stenting
• Therapeutic endoscopy

• Muscle flap
• Tracheal resection
• Tracheo-oesophageal fistula

• Humans
• Intubation, Intratracheal/adverse effects
• Suture Techniques
• Tracheal Stenosis/surgery
• Tracheoesophageal Fistula/surgery
• Tracheostomy/adverse effects

Endotherapy techniques are a recent addition to the suite of non‐surgical and minimally invasive strategies to manage patients with perforations, leaks and fistulae. The emergency nature of these conditions and the heterogeneity of pathologies encountered create difficulties when trying to select appropriate tools in these complex situations. The purpose of this article is to review experience at a tertiary academic centre, describe the various endoscopic tools available and the situations where they can be considered for use.

Single‐centre series and review of the published literature.

Of 64 patients, 57 were successfully treated using endoscopic therapy, with surgery used only to provide drainage and suture fully covered metal stents in place to prevent migration.

Selection of an appropriate endotherapy or stent for a patient with an oesophago‐gastric perforation or fistula requires an understanding of the anatomy and physiology underlying the patient's presentation and an understanding of the strengths and weaknesses of the available methods. Standard surgical principles of drainage, avoidance of distal obstruction and nutrition remain central to successful outcomes. A combination of surgical and endoscopic treatments may reduce the number of required treatments and can provide the ability to anchor fully covered stents to prevent them from migrating.

• endoscopy
• fistula
• leak
• perforation

• Bariatric surgery
• Endoscopic stent
• Leak
• Obesity
• Sleeve gastrectomy
• Therapy

• Bariatric surgery
• Endoscopic stent
• Leak
• Obesity
• Sleeve gastrectomy
• Therapy

• Adult
• Age Factors
• Humans
• Respiratory System Abnormalities/diagnosis
• Respiratory System Abnormalities/epidemiology
• Respiratory System Abnormalities/surgery

• Benign
• Biodegradable stent
• Esophageal disease
• Metal stent

• Complication
• Gastric bypass
• Laparoscopic
• Leaks
• Sleeve gastrectomy