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Background <p>Abdominal drain-associated fistulas (ADAFs) represent severe complications following gastrointestinal surgery, where conventional surgical reintervention carries invasiveness risks and extended recovery periods. This study evaluates the clinical efficacy and safety of endoscopic purse-string suturing for managing ADAFs.</p> Methods <p>A retrospective cohort analysis included 41 patients with postoperative ADAFs treated at Shandong Second Medical University and external referral centers between January 2015 and June 2024.</p> Results <p>Endoscopic intervention achieved technical success in 87.8% (36/41) of cases, with clinical success observed in 63.4% (26/41). Subgroup analysis demonstrated significantly superior clinical outcomes in isolated ADAFs versus cases involving concurrent anastomotic disruption (90.0% vs. 39.1%, <i>P</i> = 0.001). Multivariate regression identified two independent predictors of reduced therapeutic efficacy: preoperative anastomotic stenosis (OR = 0.083, <i>P</i> = 0.041) and fistulous orifice diameter &gt; 1&#xa0;cm (OR = 0.039, <i>P</i> = 0.004). During 12-month follow-up, no mortality or fistula recurrence occurred. Postprocedural anastomotic stenosis developed in 4.9% (2/41) of patients, successfully managed through endoscopic balloon dilation (<i>n</i> = 1) and gastrointestinal stent placement (<i>n</i> = 1).</p> Conclusion <p>Endoscopic purse-string suturing emerges as a minimally invasive, safe, and effective therapeutic strategy for ADAFs, particularly demonstrating optimal clinical performance in isolated drain-associated fistulas with orifices ≤ 1&#xa0;cm diameter.</p>

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Endoscopic purse-string suture technique for postoperative drain-related leakage management in gastrointestinal surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月3日

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  • Guangxu Zhu,
  • Lingai Kong,
  • Xiuwen Liu,
  • Shengjie Zhou,
  • Shunyao Song,
  • Baoqiang Shan,
  • Youchao Xu,
  • Qihang Sun,
  • Xuren Lu,
  • Qingshun Zhu,
  • Bing Jiang,
  • Cai Xu,
  • Honglei Gao,
  • Jianjun Qu

摘要

Background

Abdominal drain-associated fistulas (ADAFs) represent severe complications following gastrointestinal surgery, where conventional surgical reintervention carries invasiveness risks and extended recovery periods. This study evaluates the clinical efficacy and safety of endoscopic purse-string suturing for managing ADAFs.

Methods

A retrospective cohort analysis included 41 patients with postoperative ADAFs treated at Shandong Second Medical University and external referral centers between January 2015 and June 2024.

Results

Endoscopic intervention achieved technical success in 87.8% (36/41) of cases, with clinical success observed in 63.4% (26/41). Subgroup analysis demonstrated significantly superior clinical outcomes in isolated ADAFs versus cases involving concurrent anastomotic disruption (90.0% vs. 39.1%, P = 0.001). Multivariate regression identified two independent predictors of reduced therapeutic efficacy: preoperative anastomotic stenosis (OR = 0.083, P = 0.041) and fistulous orifice diameter > 1 cm (OR = 0.039, P = 0.004). During 12-month follow-up, no mortality or fistula recurrence occurred. Postprocedural anastomotic stenosis developed in 4.9% (2/41) of patients, successfully managed through endoscopic balloon dilation (n = 1) and gastrointestinal stent placement (n = 1).

Conclusion

Endoscopic purse-string suturing emerges as a minimally invasive, safe, and effective therapeutic strategy for ADAFs, particularly demonstrating optimal clinical performance in isolated drain-associated fistulas with orifices ≤ 1 cm diameter.