Skip to main content
SpringerLink
Log in

Endoscopic Interventions for Anastomotic Leaks and Fistulas

  • Chapter
  • First Online:
Therapeutic Endoscopy in the Gastrointestinal Tract

  • 1043 Accesses

Abstract

Despite continuing evolution of surgical procedures, anastomotic leaks in the gastrointestinal tract still give rise to a significant morbidity and mortality. By now, interventional endoscopic techniques allow a nonsurgical management of these complications in many cases. Stent therapy has become the standard in the management of anastomotic leaks in the upper gastrointestinal tract, and endoscopic vacuum therapy has become the standard for leaks of rectal anastomoses. Recently, two novel techniques have been added to the methods for endoscopic management of leaks and fistulas: endoscopic vacuum therapy in the upper gastrointestinal tract, which has been introduced into routine application, and the placement of over-the-scope clips (OTSC).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adler DG, McAfee M, Gostout CJ. Closure of an esophagopleural fistula by using fistula tract coagulation and an endoscopic suturing device. Gastrointest Endosc. 2001;54:652–3.

    Article  CAS  PubMed  Google Scholar 

  • Ahrens M, Schulte T, Egberts J, Schafmayer C, Hampe J, Fritscher-Ravens A, Broering DC, Schniewind B. Drainage of esophageal leakage using endoscopic vacuum therapy: a prospective pilot study. Endoscopy. 2010;42:693–8. doi:10.1055/s- 0030- 1255688.

    Article  CAS  PubMed  Google Scholar 

  • Albert JG, Friedrich-Rust M, Woeste G, Strey C, Bechstein WO, Zeuzem S, Sarrazin C. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc. 2011;74:389–97. doi:10.1016/j.gie.2011.03.1128.

    Article  PubMed  Google Scholar 

  • Arezzo A, Verra M, Reddavid R, Cravero F, Bonino MA, Morino M. Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas. Surg Endosc. 2012;26:3330–3. doi:10.1007/s00464-012-2340-2.

    Article  PubMed  Google Scholar 

  • Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563–76. discussion 577.

    Article  CAS  PubMed  Google Scholar 

  • Baron TH, Song LM, Ross A, Tokar JL, Irani S, Kozarek RA. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc. 2012;76:202–8. doi:10.1016/j.gie.2012.03.250.

    Article  PubMed  Google Scholar 

  • Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96. doi:10.1097/SLA.0b013e3181b13ca2.

    Article  PubMed  Google Scholar 

  • Disibeyaz S, Koksal AS, Parlak E, Torun S, Sasmaz N. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol. 2012;36:614–21. doi:10.1016/j.clinre.2012.04.015.

    Article  PubMed  Google Scholar 

  • Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H. Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy. 2003;35:652–8. doi:10.1055/s-2003-41509.

    Article  CAS  PubMed  Google Scholar 

  • Fritscher-Ravens A, Cuming T, Eisenberger CF, Ghadimi M, Nilges A, Meybohm P, Schiffmann S, Jacobsen B, Seehusen F, Niemann H, Knoefel WT. Randomized comparative long-term survival study of endoscopic and thoracoscopic esophageal wall repair after NOTES mediastinoscopy in healthy and compromised animals. Endoscopy. 2010;42:468–74. doi:10.1055/s-0029-1244019.

    Article  CAS  PubMed  Google Scholar 

  • Galizia G, Napolitano V, Castellano P, Pinto M, Zamboli A, Schettino P, Orditura M, De Vita F, Auricchio A, Mabilia A, Pezzullo A, Lieto E. The over-the-scope clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg. 2012;16:1585–9. doi:10.1007/s11605-012-1862-1.

    Article  PubMed  Google Scholar 

  • Glitsch A, von Bernstorff W, Seltrecht U, Partecke I, Paul H, Heidecke CD. Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses. Endoscopy. 2008;40:192–9. doi:10.1055/s-2007-995384.

    Article  CAS  PubMed  Google Scholar 

  • Gubler C, Bauerfeind P. Endoscopic closure of iatrogenic gastrointestinal tract perforations with the over-the-scope clip. Digestion. 2012;85:302–7. doi:10.1159/000336509.

    Article  PubMed  Google Scholar 

  • Hagel AF, Naegel A, Lindner AS, Kessler H, Matzel K, Dauth W, Neurath MF, Raithel M. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012;16:2132–8. doi:10.1007/s11605-012-1983-6.

    Article  PubMed  Google Scholar 

  • Holle G, Riedel K, von Gregory H, Gazyakan E, Raab N, Germann G. Vacuum-assisted closure therapy. Current status and basic research. Unfallchirurg. 2007;110:490–504. doi:10.1007/s00113-007-1267-x.

    Article  CAS  PubMed  Google Scholar 

  • Hunerbein M, Stroszczynski C, Moesta KT, Schlag PM. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg. 2004;240:801–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jacobsen GR, Coker AM, Acosta G, Talamini MA, Savides TJ, Horgan S. Initial experience with an innovative endoscopic clipping system. Surg Technol Int. 2012;22:39–43.

    PubMed  Google Scholar 

  • Jayaraman V, Hammerle C, Lo SK, Jamil L, Gupta K. Clinical application and outcomes of over-the-scope clip device: initial US experience in humans. Diagn Ther Endosc. 2013;2013:381873. doi:10.1155/2013/381873.

    Article  PubMed  PubMed Central  Google Scholar 

  • Junemann-Ramirez M, Awan MY, Khan ZM, Rahamim JS. Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on long-term survival in a high volume centre. Eur J Cardio-Thorac. 2005;27:3–7. doi:10.1016/j.ejcts.2004.09.018.

    Article  CAS  Google Scholar 

  • Kauer WK, Stein HJ, Dittler HJ, Siewert JR. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc. 2008;22:50–3. doi:10.1007/s00464-007-9504-5.

    Article  PubMed  Google Scholar 

  • Kirschniak A, Kratt T, Stuker D, Braun A, Schurr MO, Konigsrainer A. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc. 2007;66:162–7. doi:10.1016/j.gie.2007.01.034.

    Article  PubMed  Google Scholar 

  • Kirschniak A, Subotova N, Zieker D, Konigsrainer A, Kratt T. The over-the-scope clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc. 2011;25:2901–5. doi:10.1007/s00464-011-1640-2.

    Article  PubMed  Google Scholar 

  • Loske G, Muller C. Vacuum therapy of an esophageal anastomotic leakage — a case report. Zbl Chirurgie. 2009;134:267–70. doi:10.1055/s-0028-1098764.

    CAS  Google Scholar 

  • Maish MS, DeMeester SR, Choustoulakis E, Briel JW, Hagen JA, Peters JH, Lipham JC, Bremner CG, DeMeester TR. The safety and usefulness of endoscopy for evaluation of the graft and anastomosis early after esophagectomy and reconstruction. Surg Endosc. 2005;19:1093–102. doi:10.1007/s00464-004-8816-y.

    Article  CAS  PubMed  Google Scholar 

  • Manta R, Manno M, Bertani H, Barbera C, Pigo F, Mirante V, Longinotti E, Bassotti G, Conigliaro R. Endoscopic treatment of gastrointestinal fistulas using an over-the-scope clip (OTSC) device: case series from a tertiary referral center. Endoscopy. 2011;43:545–8. doi:10.1055/s-0030-1256196.

    Article  CAS  PubMed  Google Scholar 

  • Mennigen R, Colombo-Benkmann M, Senninger N, Laukoetter M. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the over-the-scope clip (OTSC). J Gastrointest Surg. 2013;17:1058–65. doi:10.1007/s11605-013-2156-y.

    Article  PubMed  Google Scholar 

  • Miller JD, Jain MK, de Gara CJ, Morgan D, Urschel JD. Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol. 1997;65:20–1.

    Article  CAS  PubMed  Google Scholar 

  • Mönkemüller K, Peter S, Toshniwal J, Popa D, Zabielski M, Stahl RD, Ramesh J, Wilcox CM. Multipurpose use of the «bear claw» (over-the-scope clip system) to treat endoluminal gastrointestinal disorders. Dig Endosc. 2013;26:350–7. doi:10.1111/den.12145.

    Article  PubMed  Google Scholar 

  • Nishiyama N, Mori H, Kobara H, Rafiq K, Fujihara S, Kobayashi M, Oryu M, Masaki T. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol. 2013;19:2752–60. doi:10.3748/wjg.v19.i18.2752.

    Article  PubMed  PubMed Central  Google Scholar 

  • Parodi A, Repici A, Pedroni A, Blanchi S, Conio M. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc. 2010;72:881–6. doi:10.1016/j.gie.2010.04.006.

    Article  PubMed  Google Scholar 

  • Pohl J, Borgulya M, Lorenz D, Ell C. Endoscopic closure of postoperative esophageal leaks with a novel over-the-scope clip system. Endoscopy. 2010;42:757–9. doi:10.1055/s-0030-1255634.

    Article  CAS  PubMed  Google Scholar 

  • Pross M, Manger T, Reinheckel T, Mirow L, Kunz D, Lippert H. Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses. Gastrointest Endosc. 2000;51:73–6.

    Article  CAS  PubMed  Google Scholar 

  • Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and metaanalysis. Gastrointest Endosc. 2012;75:287–93. doi: 10.1016/j.gie.2011.09.010.

  • Repici A, Arezzo A, De Caro G, Morino M, Pagano N, Rando G, Romeo F, Del Conte G, Danese S, Malesci A. Clinical experience with a new endoscopic over-the-scope clip system for use in the GI tract. Dig Liver Dis. 2009;41:406–10. doi:10.1016/j.dld.2008.09.002.

    Article  CAS  PubMed  Google Scholar 

  • Rodella L, Laterza E, De Manzoni G, Kind R, Lombardo F, Catalano F, Ricci F, Cordiano C. Endoscopic clipping of anastomotic leakages in esophagogastric surgery. Endoscopy. 1998;30:453–6. doi:10.1055/s-2007-1001307.

    Article  CAS  PubMed  Google Scholar 

  • Sandmann M, Heike M, Faehndrich M. Application of the OTSC system for the closure of fistulas, anastomosal leakages and perforations within the gastrointestinal tract. Z Gastroenterol. 2011;49:981–5. doi:10.1055/s-0029-1245972.

    Article  CAS  PubMed  Google Scholar 

  • Schlag C, Wilhelm D, von Delius S, Feussner H, Meining A. EndoResect study: endoscopic full-thickness resection of gastric subepithelial tumors. Endoscopy. 2013;45:4–11. doi:10.1055/s-0032-1325760.

    CAS  PubMed  Google Scholar 

  • Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61:891–6.

    Article  PubMed  Google Scholar 

  • Seebach L, Bauerfeind P, Gubler C. «Sparing the surgeon»: clinical experience with over-the-scope clips for gastrointestinal perforation. Endoscopy. 2010;42:1108–11. doi:10.1055/ s-0030-1255924.

    Article  CAS  PubMed  Google Scholar 

  • Surace M, Mercky P, Demarquay JF, Gonzalez JM, Dumas R, Ah-Soune P, Vitton V, Grimaud J, Barthet M. Endoscopic management of GI fistulae with the over-the-scope clip system (with video). Gastrointest Endosc. 2011;74:1416–9. doi:10.1016/j.gie.2011.08.011.

    Article  PubMed  Google Scholar 

  • Tuebergen D, Rijcken E, Mennigen R, Hopkins AM, Senninger N, Bruewer M. Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations. J Gastrointest Surg. 2008;12:1168–76. doi:10.1007/s11605-008-0500-4.

    Article  PubMed  Google Scholar 

  • van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharm Therap. 2011;33:1292–301. doi:10.1111/j.1365-2036.2011.04663.x.

    Article  Google Scholar 

  • Vikatmaa P, Juutilainen V, Kuukasjarvi P, Malmivaara A. Negative pressure wound therapy: a systematic review on effectiveness and safety. Eur J Vasc Endovasc Surg. 2008;36:438–48. doi:10.1016/j.ejvs.2008.06.010.

    Article  CAS  PubMed  Google Scholar 

  • Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M, Weusten B, Seewald S, Costamagna G, Deprez P, Fockens P. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol. 2012;10:603–8. doi:10.1016/j.cgh.2012.02.005.

    Article  PubMed  Google Scholar 

  • von Renteln D, Denzer UW, Schachschal G, Anders M, Groth S, Rosch T. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc. 2010;72:1289–96. doi:10.1016/j.gie.2010.07.033.

    Article  Google Scholar 

  • Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008;22:1818–25. doi:10.1007/s00464-007-9706-x.

    Article  PubMed  Google Scholar 

  • Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001;233:338–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Willy C, von Thun-Hohenstein H, von Lubken F, Weymouth M, Kossmann T, Engelhardt M. Experimental principles of the V.A.C. therapy — pressure values in superficial soft tissue and the applied foam. Zbl Chirurgie. 2006;131(Suppl 1):S50–61. doi:10.1055/s-2006-921421.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Proktologikum Zürich, End- und Dickdarmpraxis, Wallisellenstrasse 301A, 8050, Zürich, Switzerland

    Mario Colombo-Benkmann

  2. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Geb. W1, D-48149, Münster, Germany

    Rudolf Mennigen & Mike Laukötter

Authors
  1. Rudolf Mennigen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario Colombo-Benkmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mike Laukötter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Rudolf Mennigen or Mario Colombo-Benkmann .

Editor information

Editors and Affiliations

  1. Medical Center Mannheim, University of Heidelberg, Head of Endoscopy Department, Mannheim, Germany

    Georg Kähler

  2. University Medical Center, Interdisciplinary Endoscopy I. Medical Clinic, Tübingen, Germany

    Martin Götz

  3. Clinic of General and Visceral Surgery, University of Münster, Clinic of General and Abdominal Surgery, Münster, Germany

    Norbert Senninger

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Mennigen, R., Colombo-Benkmann, M., Laukötter, M. (2018). Endoscopic Interventions for Anastomotic Leaks and Fistulas. In: Kähler, G., Götz, M., Senninger, N. (eds) Therapeutic Endoscopy in the Gastrointestinal Tract. Springer, Cham. https://doi.org/10.1007/978-3-319-55468-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55468-6_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55467-9

  • Online ISBN: 978-3-319-55468-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation