Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer

Abstract

Background

Anastomotic complications such as leaks, bleeding, and stricture remain the most serious complications of surgery for gastric cancer. No perfect method exists for an accurate and reliable prevention of these complications. This study investigated the safety and efficacy of post-anastomotic intraoperative endoscopy (PAIOE) for avoidance of early anastomotic complications during gastrectomy in gastric cancer.

Methods

This retrospective case–control study enrolled patients from a tertiary care, academic medical center. Routine PAIOE was performed on 319 patients undergoing gastrectomy for gastric cancer between 2015 and 2016. As controls, without PAIOE 270 patients from 2013 to 2014 were used for comparison. Early anastomotic complications and outcomes after PAIOE were determined.

Results

Although there were no differences between the PAIOE and non-PAIOE group in terms of overall complication rates (20.1% vs 26.7%; P > 0.05), there were fewer complications related to anastomosis (3.4% vs 8.9%; P < 0.01) in the PAIOE group. The PAIOE group had rates of 2.5% for anastomotic leakage, 0.9% for intra-luminal bleeding, and 0% for anastomotic stenosis, while the non-PAIOE group exhibited rates of 5.6%, 2.6%, and 0.7%, respectively. Thirty-one abnormalities were detected in 26 PAIOE patients (9.71%) (20 venous bleeding, 7 mucosal tearing, 2 air leaks, 1 arterial bleeding, and 1 anastomotic stricture). All abnormalities were corrected by proper interventions (13 reinforced additional suture, 13 endoscopic hemostasis, and 2 re-anastomosis). There were no morbidities associated with PAIOE.

Conclusions

PAIOE appears to be a safe and reliable procedure to evaluate the stability of gastrointestinal anastomosis for gastric cancer patients. Further data collection and a well-designed prospective study are needed to confirm the validity of PAIOE.

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Acknowledgements

The authors would like to thank Jeong-Suk Suh, RN, and Young-Suk Kim, RN for conducting data collection.

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Correspondence to Young-Joon Lee.

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Disclosures

Drs. Ji-Ho Park, Sang-Ho Jeong, Young-Joon Lee, Tae Han Kim, Jong-Man Kim, Dong-Hwan Kim, Seung-Jin Kwag, Ju-Yeon Kim, Taejin Park, Chi-Young Jeong, Young-tae Ju, Eun-Jung Jung, and Soon-Chan Hong have no conflicts of interest or financial ties to disclose.

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Park, JH., Jeong, SH., Lee, YJ. et al. Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer. Surg Endosc 34, 5312–5319 (2020). https://doi.org/10.1007/s00464-019-07319-3

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Keywords

  • Stomach neoplasm
  • Intraoperative endoscopy
  • Postoperative complications
  • Anastomotic leak
  • Postoperative hemorrhage