Endoscopic Internal Drainage for the Management of Leak, Fistula and Collection after Sleeve Gastrectomy in 617 Consecutive Patients

Aims Leaks, fistulae and post-operative collection may occur as a complication of Sleeve Gastrectomy in up to 10 % of cases. Endoscopy plays a pivotal role in the management of adverse events following bariatric surgery. However a standardized treatment protocol is still lacking. The aim of this study is to evaluate the clinical outcome of Endoscopic Internal Drainage for the management of leaks, fistulae and collections following bariatric surgery.

Methods Retrospective observational single center study conducted from February 2012 through August 2020. All patients referred for management of AE after SG were inserted in a prospective database and retrospectively analyzed. Endoscopic Internal Drainage was used as first line treatment in case of leaks, fistulae and collections. Leaks and fistulae were treated with double pigtail stent deployment in order to guarantee drainage within the gastrointestinal lumen, sepsis control, and second intention cavity obliteration. Collection were treated with EUS guided deployment of DPS or Lumen apposing metal stent.

Results 617 patients were enrolled in the study for leak (n = 300 – 48.6 %), fistula (n = 285 – 46.2 %) and collection (n = 32 – 5.2 %). 83.3 % were female with a mean age of 43.1 at index surgery. Median follow up was of 19.5 months. Overall clinical success was 84.7 % whereas 15.3 % of cases required revisional surgery after failure of EID. Clinical success according to type of AE was 89.5 %, 78.5 % and 90 % for leak, fistula and collection respectively. 10/547 (1.8 %) presented a clinical recurrence during follow up. A total of 28 (4.5 %) AE related to endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755) and previous endoscopic treatment (OR 4.818).

Conclusions First line early EID for the management of leak, fistula and post-operative collection after SG seems safe and effective with good long term results.

Citation: Spota A, Cereatti F, Dumont JL et al. OP43 ENDOSCOPIC INTERNAL DRAINAGE FOR THE MANAGEMENT OF LEAK, FISTULA AND COLLECTION AFTER SLEEVE GASTRECTOMY IN 617 CONSECUTIVE PATIENTS. Endoscopy 2021; 53: S20.

Publication History

Article published online:
19 March 2021