Safety and efficacy of post-anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrec
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and Other Interventional Techniques
Safety and efficacy of post‑anastomotic intraoperative endoscopy to avoid early anastomotic complications during gastrectomy for gastric cancer Ji‑Ho Park1 · Sang‑Ho Jeong1 · Young‑Joon Lee1 · Tae Han Kim1 · Jong‑Man Kim1 · Dong‑Hwan Kim1 · Seung‑Jin Kwag1 · Ju‑Yeon Kim1 · Taejin Park1 · Chi‑Young Jeong1 · Young‑tae Ju1 · Eun‑Jung Jung1 · Soon‑Chan Hong1 Received: 14 June 2019 / Accepted: 5 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
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 0.05).
Surgical outcomes of the PAIOE and non‑PAIOE groups Postoperative complications between the two groups in this study are summarized in Table 2. There was no difference between the two groups in terms of overall complication and
severe complications of Clavien–Dindo classification grades III or higher. Likewise, there was no significant difference in intra-abdominal fluid collection, intra-abdominal bleeding, ileus, stasis, reoperation rate, and mortality. Although there was no significant difference in the occurrence of anastomotic leakage, intra-luminal bleeding, or anastomotic stenosis, when these three complications occurred, they were referred to as “early anastomotic complications”. The PAIOE group had significantly fewer early anastomotic complications than the non-PAIOE group (P = 0.008).
Outcomes of PAIOE Table 3 shows the types and number of positive events identified through the PAIOE procedure. There were 31 positive events including 2 air leakage (0.6%), 20 venous bleeding (6.2%), 7 mucosal tearing (2.2%), 1 arterial bleeding (0.3%), and 1 anastomotic stenosis (0.3%). Furthermore, additional reinforce suture was performed in 13 cases, endoscopic hemostasis in 13 cases, and re-anastomosis in 2 cases. Table 4 shows the intervention and hospital course of patients exhibiting positive events. Most patients were
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Surgical Endoscopy
Fig. 2 Post-anastomotic intraoperative endoscopy after distal gastrectomy with gastrojejunostomy. A Endoscope intubation, B blood clots at ga
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