Clin Endosc > Epub ahead of print
Endoscopic Internal Drainage with Double Pigtail Stents for Upper Gastrointestinal Anastomotic Leaks: Suitable for All Cases?
Bin Chet Toh1 , Jingli Chong1 , Baldwin PM Yeung1 , Chin Hong Lim2 , Eugene KW Lim2 , Weng Hoong Chan2 , Jeremy TH Tan1,2
1Upper Gastrointestinal and Bariatric Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
2Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
Correspondence :  Jeremy TH Tan ,Tel: +65-8487-6924, Fax: +65-6220-9323, Email: Jeremy.tan.t.h@singhealth.com.sg
Received: June 29, 2021  Revised: September 1, 2021   Accepted: September 2, 2021
Abstract

Background/Aims:
Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population.
Methods:
From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion.
Results:
Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining ten patients, nine (90%) did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the first week and a soft diet in the second week. One patient was allowed clear oral feeds on the 8th day after DPT insertion.
Conclusions:
Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.
Key Words: Anastomotic leak; Drainage; Stents; Upper gastrointestinal tract
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