How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience

BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition.The optimal management strategy is still unclear.AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks.METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023.Clinical outcomes were analyzed,and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus,when feasible.RESULTS Among the whole series of 60 patients,an urgent surgery was required in 8 cases due to a septic state.Fifty-six patients were managed by endoscopic or hybrid treatments,obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus.The mean time to resolution was 54.95±52.64 days,with a median of 35.5 days.No severe complications were recorded.Ten patients out of 56(17.9%)developed pneumonia that was treated by specific antibiotic therapy,and in 6 cases(10.7%)an atrial fibrillation was recorded.Seven patients(12.5%)developed a stricture within 12 months,requiring one or two endoscopic pneumatic dilations to solve the problem.Mortality was 1.7%.CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

Endoscopic techniques for gastric neuroendocrine tumors:An update

Gastric neuroendocrine neoplasms(gNENs)are a rare type of gastric neoplasm,even if their frequency is increasing according to the latest epidemiologic revisions of the main registries worldwide.They are divided into three main subtypes,with different pathogeneses,biological behaviors,and clinical characteristics.GNEN heterogeneity poses challenges,therefore these neoplasms require different management strategies.Update the knowledge on the endoscopic treatment options to manage g-NENs.This manuscript is a narrative review of the literature.In recent years,many advances have been made not only in the knowledge of both the pathogenesis and the molecular profiling of gNENs but also in the endoscopic expertise towards innovative treatment options,which proved to be less aggressive without losing the capa-bility of being radical.The endoscopic approach is increasingly applied in the field of gastrointestinal(GI)luminal neoplasms,and this is true not only for adenocarcinomas but also for gNENs.In particular,different techniques have been described for the endoscopic removal of suspected lesions,ranging from classical polypectomy(cold or hot snare)to endoscopic mucosal resection(both with“en bloc”or piecemeal technique),endoscopic submucosal dissection,and endoscopic full-thickness resection.GNENs comprise different subtypes of neoplasms with distinct management and prognosis.New endoscopic techniques offer a wide variety of approaches for GI localized neoplasms,which demonstrated to be appropriate and effective also in the case of gNENs.Correct evaluation of size,site,morphology,and clinical context allows the choice of tailored therapy in order to guarantee a definitive treatment.