ENDOSCOPIC CLIPPING OF ANASTOMOTIC LEAKAGES IN ESOPHAGOGASTRIC SURGERY

Background and Study Aims: Anastomotic leakage is a severe complicatio n in gastric surgery and it is associated with a high rate of mortalit y. Conservative treatment sometimes is not sufficient to stem the leak ages and, even when it is sufficient, it takes a long time. The presen t study describes the first experience in the treatment of anastomotic leakages with endoscopic clipping. Patients and Methods: From May 199 5 to December 1996, seven patients with postoperative anastomotic leak ages after gastric surgery were prospectively treated in our Endoscopy Service. Metallic endoclips (MD 850, Olympus Corp., Tokyo, Japan) wit h prongs 12 mm long and 6 mm wide were applied, controlling the closur e of the leakage by endoscopy; using radiographs to confirm the closur e 24 hours later. Results: Complete closure of the leakage was obtaine d in all seven cases. A single session of endoscopic clipping was need ed for five patients while two other required, respectively, two and t hree sessions. The median time of leakage closure after endoscopic cli pping was 2.3 days (range 1-5 days). The clips spontaneously dislodged within 1 month in five patients and within the second month in the ot her two patients. Conclusion: Endoscopic treatment of anastomotic leak ages by metallic clips represents a safe and easily repeated method an d, compared to conservative treatment, it seems to offer several time and cost advantages. Further studies involving a larger number of pati ents are needed to verify this finding.