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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2022; 13(03): 136-140
DOI: 10.1055/s-0042-1754333
Research Article

Endoscopic Self-Expanding Metallic Stent Placement in the Management of Post Laparoscopic Sleeve Gastrectomy Complications

Hamidreza Goudarzi 
1   Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
,
Jacob R. Obney 
2   Department of Biology, Texas Tech University, Lubbock, Texas, United States
,
Mahsa Hemmatizadeh 
1   Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
,
Taha Anbara
1   Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
› Author Affiliations Funding None.
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Abstract

Introduction Endoscopic treatments have become popular by providing the best solution for healing complications while allowing oral nutrition. In this study, we aim to evaluate outcomes of the endoscopic-covered stents for staple line complications following bariatric surgery.

Methods A prospective evaluation was performed for all patients treated for staple line complications after bariatric surgery. Bariatric patients with acute leaks, chronic gastrocutaneous fistulas, and anastomotic strictures refractory to endoscopic dilation after sleeve gastrectomy were included in this survey.

Results From January 2019 to June 2020, 41 patients (12 with acute leaks, 16 with chronic fistulas, and 13 with strictures) were treated with endoscopic silicone-covered stents (polyester or nitinol). The mean follow-up was 3.5 months. Immediate symptomatic improvement occurred in 95.2% (91.7% of acute leaks, 81.2% of fistulas, and 92.3% of strictures). In addition, 87.8% of patients initiated oral feeding immediately after stenting. There was no mortality case in this population.

Conclusion Although stent migration rarely occurs in subjects, the endoscopic silicone-covered stents strategy is one of the best treatments for anastomotic complications after bariatric surgery, providing rapid healing while simultaneously allowing for oral nutrition.

Keywords

endoscopic treatment - bariatric surgery - leakage

Authors' Contributions

HG and MH designed and collected the data, JO analyzed the results, and TA and HG performed and wrote the draft.


Availability of Data and Materials

Readers can reach the data and materials through direct contact with the correspond author's email.


Consent for Publication

Not applicable.




Publication History

Article published online:
13 September 2022

© 2022. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and meta-analysis. PLoS Med 2020; 17 (07) e1003206
    CrossrefPubMedGoogle Scholar
  • 2 Lalor PF, Tucker ON, Szomstein S, Rosenthal RJ. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2008; 4 (01) 33-38
    CrossrefPubMedGoogle Scholar
  • 3 DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg 2002; 235 (05) 640-645 , discussion 645–647
    CrossrefPubMedGoogle Scholar
  • 4 Salinas A, Baptista A, Santiago E, Antor M, Salinas H. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis 2006; 2 (05) 570-572
    CrossrefPubMedGoogle Scholar
  • 5 Dai Y, Chopra SS, Kneif S, Hünerbein M. Management of esophageal anastomotic leaks, perforations, and fistulae with self-expanding plastic stents. J Thorac Cardiovasc Surg 2011; 141 (05) 1213-1217
    CrossrefPubMedGoogle Scholar
  • 6 Schubert D, Scheidbach H, Kuhn R. et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005; 61 (07) 891-896
    CrossrefPubMedGoogle Scholar
  • 7 Pines G, Bar I, Elami A. et al. Modified endoscopic vacuum therapy for nonhealing esophageal anastomotic leak: technique description and review of literature. J Laparoendosc Adv Surg Tech A 2018; 28 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 8 Jung CFM, Müller-Dornieden A, Gaedcke J. et al. Impact of endoscopic vacuum therapy with low negative pressure for esophageal perforations and postoperative anastomotic esophageal leaks. Digestion 2019; •••: 1-11
    Google Scholar
  • 9 Manfredi M, Gottrand F, Dall'Oglio L. et al. Endoscopic management of esophageal strictures. Pract Pediatr Gastrointest Endosc 2021; 221-33
    CrossrefGoogle Scholar
  • 10 Hany M, Ibrahim M, Zidan A. et al. Role of primary use of mega stents alone and combined with other endoscopic procedures for early leak and stenosis after bariatric surgery, single-institution experience. Obes Surg 2021; 31 (05) 2050-2061
    CrossrefPubMedGoogle Scholar
  • 11 Fukumoto R, Orlina J, McGinty J, Teixeira J. Use of Polyflex stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obes Relat Dis 2007; 3 (01) 68-71 , discussion 71–72
    CrossrefPubMedGoogle Scholar
  • 12 Rogalski P, Swidnicka-Siergiejko A, Wasielica-Berger J. et al. Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis. Surg Endosc 2021; 35 (03) 1067-1087
    CrossrefPubMedGoogle Scholar
  • 13 Chung Y, Park DG, Kim YJ. Endoscopic management of staple line leak after bariatric surgery: surgeon's perspective. Clin Endosc 2021; 54 (06) 805-809
    CrossrefPubMedGoogle Scholar
  • 14 Jaruvongvanich V, Matar R, Storm AC. et al. Endoscopic management of refractory leaks and fistulas after bariatric surgery with long-term follow-up. Surg Endosc 2021; 35 (06) 2715-2723
    CrossrefPubMedGoogle Scholar
  • 15 Kheirvari M, Akbarzadeh I, Eshghjoo S. et al. Diagnostic value of erythrocyte sedimentation rate levels as a predictor of staple-line leakage in bariatric surgery. Bariatr Surg Pract Patient Care 2020; 15 (04) 231-235 Available from https://www.liebertpub.com/doi/10.1089/bari.2019.0046 [Internet]. Accessed July 1, 2022
    CrossrefGoogle Scholar
  • 16 Eubanks S, Edwards CA, Fearing NM. et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg 2008; 206 (05) 935-938 , discussion 938–939
    CrossrefPubMedGoogle Scholar
  • 17 Anbara T. The relationship between bleeding and age in sleeve gastrectomy subjects. Obes Med 2021; 24: 100344
    CrossrefGoogle Scholar
  • 18 Al Hajj GN, Haddad J. Preventing staple-line leak in sleeve gastrectomy: reinforcement with bovine pericardium vs. oversewing. Obes Surg 2013; 23 (11) 1915-1921
    CrossrefPubMedGoogle Scholar
  • 19 Al-Rashedy M, Ghosh A, Mukherjee T. et al. The role of relaparoscopy in the management of early bariatric surgery complications and 30-day outcome: a tertiary centre experience. Obes Surg 2021; 31 (08) 3462-3467
    CrossrefPubMedGoogle Scholar
  • 20 Alizadeh RF, Li S, Inaba C. et al. Risk factors for gastrointestinal leak after bariatric surgery: MBASQIP analysis. J Am Coll Surg 2018; 227 (01) 135-141
    CrossrefPubMedGoogle Scholar
  • 21 Lazzara C, Osorio J, Valcarcel J, Pujol-Gebellí J. Gastrointestinal bleeding after laparoscopic duodenal switch and SADI-S caused by pseudoaneurysm of gastroduodenal artery: first reported cases. Obes Surg 2021; 31 (07) 3330-3332
    CrossrefPubMedGoogle Scholar
  • 22 Sundaresan N, Sullivan M, Hiticas BA. et al. Impacts of gastrojejunal anastomotic technique on rates of marginal ulcer formation and anastomotic bleeding following Roux-en-Y gastric bypass. Obes Surg 2021; 31 (07) 2921-2926
    CrossrefPubMedGoogle Scholar
  • 23 Langer FB, Wenzl E, Prager G. et al. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 2005; 79 (02) 398-403 , discussion 404
    CrossrefPubMedGoogle Scholar
  • 24 Yemini R, Nesher E, Braun M. et al. Long-term outcomes of Roux-en-Y gastric bypass or sleeve gastrectomy in patients with cirrhosis; before, during or after liver transplantation: a single center's experience. Clin Transplant 2021; 35 (08) e14374
    CrossrefPubMedGoogle Scholar
  • 25 Thaher O, Wolf S, Hukauf M, Stroh C. Propensity score-matching sleeve gastrectomy (SG) vs. gastric bypass (RYGB) in patients ≥ 60 years. Obes Surg 2021; 31 (06) 2682-2690
    CrossrefPubMedGoogle Scholar
  • 26 Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 2012; 26 (06) 1509-1515
    Google Scholar
  • 27 Sumer A, Mahawar K, Aktokmakyan TV. et al. Bridged one-anastomosis gastric bypass: technique and preliminary results. Surg Today 2021; 51 (08) 1371-1378
    CrossrefPubMedGoogle Scholar
  • 28 Khalaf M, Hamed H. Single-anastomosis sleeve ileal (SASI) bypass: hopes and concerns after a two-year follow-up. Obes Surg 2021; 31 (02) 667-674
    CrossrefPubMedGoogle Scholar
  • 29 Siddique I. Endoscopic management of leak and abscess following laparoscopic sleeve gastrectomy. In: Laparoscopic Sleeve Gastrectomy. Springer, Cham; 2021: 443-460
    CrossrefGoogle Scholar
  • 30 Neto MG, Quadros LG, Azor FO. Endoscopic diagnosis and treatment of bariatric surgery complications. Dig Dis Interv 2021; 5 (02) 169-176
    Article in Thieme ConnectGoogle Scholar
  • 31 Süsstrunk J, Thumshirn M, Peterli R, Kraljević M. Early gastrogastric fistula after Roux-en-Y gastric bypass: successful fistula treatment with self-expandable endoscopic stent. BMJ Case Rep 2021; 14 (06) e243748
    CrossrefPubMedGoogle Scholar
  • 32 Cirera de Tudela A, Vilallonga R, Ruiz-Úcar E. et al. Management of leak after single anastomosis duodeno-ileal bypass with sleeve gastrectomy. J Laparoendosc Adv Surg Tech A 2021; 31 (02) 152-160
    CrossrefPubMedGoogle Scholar