title: Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage.
abstract: BACKGROUND
  The purpose of this study was to evaluate the safety and efficacy of endoscopic therapy, an alternative and less invasive modality for the management of leakage after gastrectomy.
  
  
  METHODS
  An electronic database of 35 patients with anastomotic leaks after surgery for stomach cancer that were treated with either an endoscopic procedure or surgery between January 2004 and March 2012 was reviewed. The success rates and safety of both modalities were evaluated.
  
  
  RESULTS
  Endoscopic treatment was performed in 20 patients and surgical treatment in 15 patients. The median time interval between the primary surgery and diagnosis of leakage was 8.0 days (interquartile range, 5.0-14.0 days). Of the 20 patients with endoscopic treatment, technical success was achieved in 19 patients (95 %) with resulting clinical success achieved in all of these 19 patients (100 %). One patient with failed endoscopic management went on to receive surgery. There were no cases of leakage-related deaths after endoscopic treatment. Of the 15 patients with surgical treatment, 5 died due to sepsis, bleeding, or hospital-acquired pneumonia. For diagnosis of leakage, 17 patients from the endoscopy group underwent computed tomography (CT) scanning, which revealed leakages in 3 patients (17.6 %) and occult leakages were subsequently defined at fluoroscopy in all 20 patients. Seven of twelve patients (58.3 %) from the surgical group had leakages diagnosed by CT scan.
  
  
  CONCLUSIONS
  Endoscopic treatment can be considered a valuable option for the management of postoperative anastomotic leakage with a high degree of technical feasibility and safety, particularly for leakages that are not excessively large.
authors.affiliation: Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, No. 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea, seohyunism@naver.com.
authors.forename: Seohyun
authors.initials: S
authors.lastname: Lee
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Kwi-Sook
authors.initials: KS
authors.lastname: Choi
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Beom Su
authors.initials: BS
authors.lastname: Kim
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.forename: Sung Tae
authors.initials: ST
authors.lastname: Oh
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome