Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

Périssé, Luís Gustavo Santos; Perissé, Paulo Cézar Marques; Júnior, Celso Bernardo

doi:10.1590/0100-69912015003006

Cited by 7 publications

(3 citation statements)

References 27 publications

(41 reference statements)

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“…One reported gastrointestinal perforation [38]. Two studies showed minor bleeding as a complication of stenting [32,34]. Some patients reported dysphagia and vomiting as a result of esophageal stenosis due to tissue hyperplasia, obstruction of the stent with food, or stent collapse [21,27,34,37,40].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis

et al. 2020

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Background Endoscopic techniques have become the first-line therapy in bariatric surgery-related complications such as leaks and fistulas. We performed a systematic review and meta-analysis on the effectiveness of self-expandable stents, clipping, and tissue sealants in closing of post-bariatric surgery leak/fistula. Methods A systematic literature search of the Medline/Scopus databases was performed to identify full-text articles published up to February 2019 on the use of self-expandable stents, clipping, or tissue sealants as primary endoscopic strategies used for leak/fistula closure. Meta-analysis of studies reporting stents was performed with the PRISMA guidelines. Results Data concerning the efficacy of self-expanding stents in the treatment of leaks/fistulas after bariatric surgery were extracted from 40 studies (493 patients). The overall proportion of successful leak/fistula closure was 92% (95% CI, 90-95%). The overall proportion of stent migration was 23% (95% CI, 19-28%). Seventeen papers (98 patients) reported the use of clipping: the over-the-scope clips (OTSC) system was used in 85 patients with a successful closure rate of 67.1% and a few complications (migration, stenosis, tear). The successful fistula/leak closure using other than OTSC types was achieved in 69.2% of patients. In 10 case series (63 patients), fibrin glue alone was used with a 92.8-100% success rate of fistula closure that usually required repeated sessions at scheduled intervals. The complications of fibrin glue applications were reported in only one study and included pain and fever in 12.5% of patients. Conclusions Endoscopic techniques are effective for management of post-bariatric leaks and fistulas in properly selected patients.

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Section: Discussionmentioning

confidence: 99%

Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis

et al. 2020

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“…Eight studies had reported deaths in their studies. 33,43,44,46,47,48,50,51 The overall mortality rate was 2.05% (10 out of 488 patients). Nevertheless, these events were not caused directly by endoscopic interventions but were the result of the patients' severe condition prior to endoscopic treatment.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

Stent Management of Leaks After Bariatric Surgery: a Systematic Review and Meta-analysis

et al. 2022

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BACKGROUND Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results. METHODSWe performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality. RESULTSA meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89 % (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65 % (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54 % (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's value of 1.0. No deaths were caused directly by complications with the stent placement. CONCLUSION Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.

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“…A utilização do tratamento endoscópico na abordagem das complicações associadas à cirurgia bariátrica tem sido amplamente estudado (DE OLIVEIRA et al, 2023;KOULADOUROS, 2023). Inicialmente foi utilizado para correções de fístulas malignas e para a perfuração espontânea do esôfago (síndrome de Böerhaave) e, posteriormente, proposto para as fístulas pós-operatórias (PALERMO et al, 2015;PÉRISSÉ;PÉRISSÉ;JUNIOR, 2015).…”

Section: Introductionunclassified

Vácuo endoscópico no manejo de fístulas pós cirúrgia bariátrica: uma revisão narrativa de literatura

Becker,

Meurer,

Bobato

et al. 2024

Braz. J. Hea. Rev.

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A obesidade é uma condição complexa caracterizada pelo excesso de gordura corporal, associada a inflamação crônica e problemas metabólicos. Seu tratamento requer uma abordagem abrangente, incluindo mudanças no estilo de vida e, em alguns casos, cirurgia bariátrica, que pode levar a complicações como fístulas gastrointestinais. O manejo dessas fístulas é desafiador e exige uma equipe multidisciplinar. A terapia endoscópica a vácuo (TEV) surge como uma opção inovadora e menos invasiva para lidar com essas complicações, utilizando pressão negativa para promover a cicatrização do defeito. Este estudo pretende esclarecer o papel da TEV como uma abordagem segura no tratamento de fístulas gastrointestinais transmurais após cirurgia bariátrica.

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Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

Abstract: endoscopic treatment with fully coated self-expandable prosthesis was effective in treating most patients with fistula after sleeve gastrectomy and roux en y gastric bypass.

Cited by 7 publications

References 27 publications

Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis

Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis

Stent Management of Leaks After Bariatric Surgery: a Systematic Review and Meta-analysis

Vácuo endoscópico no manejo de fístulas pós cirúrgia bariátrica: uma revisão narrativa de literatura

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