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Surgical Endoscopy

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Open Access 01-04-2019 | Endoscopy | Review Article

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Authors: R. E. Clifford, H. Fowler, N. Govindarajah, D. Vimalachandran, P. A. Sutton

Published in: Surgical Endoscopy | Issue 4/2019

Abstract

Background

Anastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.

Method

A literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string “colorectal anastomotic (“leak” OR “bleed”), “endoscopy”, endoscopic management”. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.

Results

A total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.

Conclusion

Endoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.

Bowel Cancer. Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/bowel-cancer. Accessed 8 Sept 2018

Blumetti J, Abcarian H (2015) Management of low colorectal anastomotic leak: preserving the anastomosis. World J Gastrointest Surg 7(12):378–383. https://doi.org/10.4240/wjgs.v7.i12.378 CrossRefPubMedPubMedCentral

Hain E, Maggiori L, Manceau G, Mongin C, Prost À, la Denise J, Panis Y (2017) Oncological impact of anastomotic leakage after laparoscopic mesorectal excision. Br J Surg 104(3):288–295. https://doi.org/10.1002/bjs.10332 CrossRefPubMed

Vermeer TA, Orsini RG, Daams F, Nieuwenhuijzen G, Rutten H (2014) Anastomotic leakage and presacral abscess formation after locally advanced rectal cancer surgery: incidence, risk factors and treatment. EJSO 40(11):1502–1509. https://doi.org/10.1016/j.ejso.2014.03.019 CrossRefPubMed

Chopra SS, Mrak K, Hünerbein M (2009) The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 145:182–188. https://doi.org/10.1016/j.surg.2008.09.012 CrossRefPubMed

Soeters PB, de Zoete JP, Dejong CH, Williams NS, Baeten CG (2002) Colorectal surgery and anastomotic leakage. Dig Surg 19:150–155. https://doi.org/10.1159/000052031 CrossRefPubMed

Sciuto A, Merola G, Palma G, Sodo M, Pirozzi F, Bracale U, Bracale U (2018) Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 21: 2247–2260. https://doi.org/10.3748/wjg.v24.i21.2247 CrossRef

Leenen JPL, Hentzen JEKR, Ockhuijsen HDL (2018) Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Updates Surg. https://doi.org/10.1007/s13304-018-0526-4 CrossRefPubMed

Guerra F, Giuliani G, Coletta D, Boni M, Rondelli F, Bianchi PP et al (2018) A Meta-analysis of randomized controlled trials on the use of suction drains following rectal surgery. Dig Surg 35(6):482–490. https://doi.org/10.1159/000485139 CrossRefPubMed

10.

Hedrick TL, Sawyer RG, Foley EF, Friel CM (2006) Anastomotic leak and the loop ileostomy: friend or foe? Dis Colon Rectum 49(8):1167–1176. https://doi.org/10.1007/s10350-006-0602-6 CrossRefPubMed

11.

Khan AA, Wheeler JM, Cunningham C, George B, Kettlewell M, Mortensen NJ (2008) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 10(6):587–592. https://doi.org/10.1111/j.1463-1318.2007.01417.x CrossRefPubMed

12.

Blumetti J, Chaudhry V, Cintron JR, Park JJ, Marecik S, Harrison JL (2014) Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg 38(4):985–991. https://doi.org/10.1007/s00268-013-2340-y CrossRefPubMed

13.

Krarup PM, Jorgensen LN, Harling H, Danish Colorectal Cancer Group (2014) Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg 218(5):940–949. https://doi.org/10.1016/j.jamcollsurg.2014.01.051 CrossRefPubMed

14.

Hallböök O, Sjödahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. BJS 83(1):60–62. https://doi.org/10.1002/bjs.1800830119 CrossRef

15.

Nesbakken A, Nygaard K, Lunde OC (2002) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88(3):400–404. https://doi.org/10.1046/j.1365-2168.2001.01719.x CrossRef

16.

Arezzo A, Bini R, Lo Secco G, Verra M, Passera R (2017) The role of stents in the management of colorectal complications: a systematic review. Surg Endosc https://doi.org/10.1007/s00464-016-5315-x CrossRefPubMed

17.

Abbas MA (2009) JSLS 13(3):420–424. http://www.ncbi.nlm.nih.gov/pubmed. Accessed 8 Sept 2018

18.

Amrani L, Me´nard C, Berdah S et al (2009) From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of ‘‘stent-guided regeneration and re-epithelialization’’. Gastrointest Endosc 69:1282–1287CrossRefPubMed

19.

Chi P, Wang X, Lin H, Lu X, Huang Y (2015) Endoscopic covered self-expandable metal stents implantation in the management of anastomotic leakage after colorectal cancer surgery. Zhonghua Wei Chang Wai Ke Za Zhi 7:661–666. http://www.ncbi.nlm.nih.gov/pubmed. Accessed 8 Sept 2018

20.

Cooper CJ, Morales A, Othman MO (2014) Outcomes of the use of fully covered esophageal self-expandable stent in the management of colorectal anastomotic strictures and leaks. Diagn Ther Endosc. https://doi.org/10.1155/2014/187541 CrossRefPubMedPubMedCentral

21.

DiMaio CJ, Dorfman MP, Gardner GJ, Nash GM, Schattner MA, Markowitz AJ (2012) Covered esophageal self-expandable metal stents in the nonoperative management of postoperative colorectal anastomotic leaks. Gastrointest Endosc 76(2):431–435. https://doi.org/10.1016/j.gie.2012.03.1393 CrossRefPubMed

22.

Lamazza A, Sterpetti AV, De Cesare A et al (2015) Endoscopic placement of self-expanding stents in patients with symp- tomatic anastomotic leakage after colorectal resection for cancer: long-term results. Endoscopy 47:270–272CrossRefPubMed

23.

Manta R, Caruso A, Cellini C, Sica M, Zullo A, Mirante V, Bertani H, Frazzoni M, Mutignani M, Galloro G, Conigliaro R (2016) Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: a large case series. United Eur Gastroenterol J 4(6): 770–777. https://doi.org/10.1177/2050640615626051ueg.sagepub.com CrossRef

24.

Perez Rolda´n F, Gonza´lez Carro P, Villafa´n˜ez Garcı´a MC et al (2013) Endoscopic treatment of postsurgical colorectal anastomotic leak. Gastrointest Endosc 77:967–971CrossRef

25.

Mennigen R, Colombo-Benkmann M, Senninger N, Laukoetter M (2013) Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the over-the-scope clip (OTSC). J Gastrointest Surg. 6:1058–1065. https://doi.org/10.1007/s11605-013-2156-y CrossRef

26.

Kirschniak A, Kratt T, Stüker D, Braun A, Schurr MO, Königsrainer A (2007) Gastrointest Endosc 66(1):162–167. https://doi.org/10.1016/j.gie.2007.01.034 CrossRefPubMed

27.

Arezzo A, Verra M, Reddavid R, Cravero F, Bonino MA, Morino M (2012) Surg Endosc 11:3330–3333. https://doi.org/10.1007/s00464-012-2340-2 CrossRef

28.

Kirschniak A, Subotova N, Zieker D, Königsrainer A, Kratt T (2011) Surg Endosc 25(9):2901–2905. https://doi.org/10.1007/s00464-011-1640-2 CrossRefPubMed

29.

Kobayashi H, Kikuchi A, Okazaki S, Ishiguro M, Ishikawa T, Lida S, Uetake H, Suqihara A (2014) World J Gastroenterol 20(24):7984–7987. https://doi.org/10.3748/wjg.v20.i24.7984 CrossRefPubMedPubMedCentral

30.

Voermans RP, Le Moine O, von Renteln D, Ponchon T, Giovannini M, Bruno M (2012) CLIPPER Study Group. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol. 10(6):603–608. https://doi.org/10.1016/j.cgh.2012.02.005.CrossRefPubMed

31.

Arezzo A, Miegge A, Garbarini A, Morino M (2010) Endoluminal vacuum therapy for anastomotic leaks after rectal surgery. Tech Coloproctol 14(3):279–281. https://doi.org/10.1007/s10151-010-0569-0 CrossRefPubMed

32.

Argenta LC, Morykwas MJ (1997) Ann Plast Surg 38(6):563–576. http://www.ncbi.nlm.nih.gov/pubmed. Accessed 8 Sept 2018

33.

Glitsch A, von Bernstorff W, Seltrecht U, Partecke I, Paul H, Heidecke CD (2008) Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses. Endoscopy 40(3):192–199. https://doi.org/10.1055/s-2007-995384 CrossRefPubMed

34.

Kuehn F, Janisch F, Schwandner F, Alsfasser G, Schiffmann L, Gock M, Klar E (2016) J Gastrointest Surg 20(2):328–334. https://doi.org/10.1007/s11605-015-3017-7 CrossRefPubMed

35.

Mees ST, Palmes D, Menninger R, Senninger N, Haier J, Bruewer M (2008) Endo-vacuum assisted closure treat-ment for rectal anastomotic insufficiency. Dis Colon Rectum 5:404–410CrossRef

36.

Nerup N, Johansen JL, Alkhefagie GA, Maina P, Jensen K (2013) Promising results after endoscopic vacuum treatment of anastomotic leakage following resection of rectal cancer with ileostomy. Dan Med J 60:A4604PubMed

37.

Riss S, Stift A, Kienbacher C, Dauser B, Haunold I, Kriwanek S, Radlsboek W, Bergmann M (2010) Recurrent abscess after primary successful endo-sponge treatment of anastomotic leakage following rectal surgery. World J Gastroenterol 36:4570–4574CrossRef

38.

Srinivasamurthy D, Wood C, Slater R, Garner J (2013) Tech Coloproctol 17(3):275–281. https://doi.org/10.1007/s10151-012-0911-9 CrossRefPubMed

39.

Strangio G, Zullo A, Ferrara EC, Anderloni A, Carlino A, Jovani M, Ciscato C, Hassan C, Repici A (2015) Dig Liver Dis 47(6):465–469. https://doi.org/10.1016/j.dld.2015.02.007 CrossRefPubMed

40.

Bernstorff W, Glitsch A, Schreiber A, Partecke L, Heidecke C (2009) ETVARD (endoscopic transanal vacuum-assisted rectal drainage) leads to complete but delayed closure of extraperitoneal rectal anastomotic leakage cavities following neoadjuvant radiochemotherapy. Int J Colorecatl Dis 24:819–825. https://doi.org/10.1007/s00384-009-0673-7 CrossRef

41.

Van Koperen PJ, van Berge Henegouwen MI, Rosman C, Bakker CM, Heres P, Slors JF, Bemelman WA (2009) Surg Endosc 23(6):1379–1383. https://doi.org/10.1007/s00464-008-0186-4 CrossRefPubMed

42.

Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2008) Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 22(8):1818–1825. https://doi.org/10.1007/s00464-007-9706-x.CrossRefPubMed

43.

Blot C, Sabbagh C, Rebibo L, Brazier F, Chivot C, Fumery M, Regimbeau JM (2016) Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study. Surg Endosc 30(5):1869–1875. https://doi.org/10.1007/s00464-015-4404-6 CrossRefPubMed

44.

Al-Maawali AK, Nguyen P, Phang PT (2016) Modern treatments and stem cell therapies for Perianal Crohn’s fistulas. Can J Gastroenterol Hepatol. https://doi.org/10.1155/2016/1651570 CrossRefPubMedPubMedCentral

45.

Del Rio P, Dell’Abate P, Soliani P, Ziegler S, Arcuri M, Sianesi M (2005) Endoscopic treatment of esophageal and colo-rectal fistulas with fibrin glue. Acta Biomed. 76(2):95–98. http://www.ncbi.nlm.nih.gov/pubmed. Accessed 8 Sept 2018.

46.

Lippert E, Klebl FH, Schweller F, Ott C, Gelbmann CM, Schölmerich J, Endlicher E, Kullmann F (2011) Fibrin glue in the endoscopic treatment of fistulae and anastomotic leakages of the gastrointestinal tract. Int J Colorectal Dis. 26(3):303–311. https://doi.org/10.1007/s00384-010-1104-5.CrossRefPubMed

47.

Lou Z, Zhang W, Yu E, Meng R, Fu C (2014) Colonoscopy is the first choice for early postoperative rectal anastomotic bleeding. World J Surg Oncol 12:376. https://doi.org/10.1186/1477-7819-12-376 CrossRefPubMedPubMedCentral

48.

Besson R, Christidis C, Denet C, Bruyns L, Levard H, Gayet B (2016) Management of postoperative bleeding after laparoscopic left colectomy. Int J Colorectal Dis 31(8):1431–1436. https://doi.org/10.1007/s00384-016-2612-8 CrossRefPubMed

49.

Neutzling CB, Lustosa S, Proenca I, Silva E, Matos D (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Syst Rev. https://doi.org/10.1002/14651858.CD003144.pub2 CrossRef

50.

Malik AH, East JE, Buchanan GN, Kennedy RH (2008) Endoscopic haemostasis of staple-line haemorrhage following colorectal resection. Colorectal Dis 10(6):616–618. https://doi.org/10.1111/j.1463-1318.2007.01459.x CrossRefPubMed

51.

Martínez-Serrano MA, Parés D, Pera M, Pascual M, Courtier R, Egea MJ, Grande L (2009) Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol 13(1):49–53. https://doi.org/10.1007/s10151-009-0458-6 CrossRefPubMed

52.

Perez RO, Sousa A Jr, Bresciani C, Proscurshim I, Coser R, Kiss D, Habr-Gama A (2007) Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage. Tech Coloproctol 11(1):64–66. https://doi.org/10.1007/s10151-007-0330-5 CrossRefPubMed

53.

Simpson GS, Smith R, Sutton P, Shekouh A, McFaul C, Johnson M, Vimalachandran D (2014) The aetiology of delay to commencement of adjuvant chemotherapy following colorectal resection. Int J Surg Oncol. https://doi.org/10.1155/2014/670212 CrossRefPubMedPubMedCentral

54.

Ashburn JH, Stocchi L, Kiran RP, Dietz DW, Remzi FH (2013 Mar) Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon Rectum 56(3):275–280. https://doi.org/10.1097/DCR.0b013e318277e8a5 CrossRefPubMed

55.

Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP (2012) Pelvic sepsis after iPaa adversely affects function of the pouch and quality of life. Dis Colon Rectum 55:387–392CrossRef

56.

Mongin C, Maggiori L, Agostini J, Ferron M, Panis Y (2014) Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Colorectal Dis 29(4):459–467. https://doi.org/10.1007/s00384-014-1833-y CrossRefPubMed

Title: Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage
Authors: R. E. Clifford
H. Fowler
N. Govindarajah
D. Vimalachandran
P. A. Sutton
Publication date: 01-04-2019
Publisher: Springer US
Keywords: Endoscopy
Vacuum Therapy
Vacuum Therapy
Enterostomy
Vacuum Therapy
Enterostomy
Published in: Surgical Endoscopy / Issue 4/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06670-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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