Drain Amylase Levels May Indicate Gastrojejunostomy Leaks After Roux-en-Y Gastric Bypass

Ribeiro, Igor Braga; Gestic, Martinho Antônio; Chaim, Felipe David Mendonça; Chaim, Élinton Adami; Cazzo, Everton

doi:10.1590/s0004-2803.201800000-13

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…Surgery has been the primary treatment of MCO for decades although surgical morbidity and mortality are higher in emergency scenarios than in elective procedures 4 5 6 . In the mid-1990 s, endoscopic self-expanding metal stents (SEMS) emerged as a treatment for gastrointestinal surgical emergencies 7 8 9 , including MCO, and the first studies raised high expectations because use of stents could avoid surgical intervention such as colostomy, leading to reduced morbidity and mortality, possibly resulting in higher quality of life (QOL) 10 11 .…”

Section: Introductionmentioning

confidence: 99%

Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis

et al. 2018

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Background and study aims Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer death worldwide. Malignant colonic obstruction (MCO) due to CRC occurs in 8 % to 29 % of patients.The aim of this study was to perform a systematic review and meta-analysis of RCTs comparing colonic SEMS versus emergency surgery (ES) for MCO in palliative patients. This was the first systematic review that included only randomized controlled trials in the palliative setting. Methods A literature search was performed according to the PRISMA method using online databases with no restriction regarding idiom or year of publication. Data were extracted by two authors according to a predefined data extraction form. Primary outcomes were: mean survival, 30-day adverse events, 30-day mortality and length of hospital stay. Stoma formation, length of stay on intensive care unit (ICU), technical success and clinical success were recorded for secondary outcomes. Technical success (TS) was defined as successful stent placement across the stricture and its deployment. Clinical success (CS) was defined as adequate bowel decompression within 48 h of stent insertion without need for re-intervention. Results We analyzed data from four RCT studies totaling 125 patients. The 30-day mortality was 6.3 % for SEMS-treated patients and 6.4 % for ES-treated patients, with no difference between groups (RD: – 0.00, 95 % CI [–0.10, 0.10], I 2 : 0 %). Mean survival was 279 days for SEMS and 244 days for ES, with no significant difference between groups (RD: 20.14, 95 % CI: [–42.92, 83.21], I 2 : 44 %). Clinical success was 96 % in the ES group and 86.1 % in the SEMS group (RD: – 0.13, 95 % CI [–0.23, – 0.02], I 2 : 51 %). Permanent stoma rate was 84 % in the ES group and 14.3 % in the SEMS group (RR: 0.19, 95 % CI: [0.11, 0.33], I 2 : 28 %). Length of hospital stay was shorter in SEMS group (RD: – 5.16, 95 % CI: [–6.71, – 3.61], I 2 : 56 %). There was no significant difference between groups regarding adverse events (RD 0.18, 95 % CI: [–0.19, 0.54;]) neither regarding ICU stay. (RD: – 0.01, 95 % CI: [–0.08, 0.05], I 2 : 7 %). The most common stent-related complication was perforation (42.8 % of all AE). Conclusion Mortality, mean survival, length of stay in the ICU and early complications of both methods were similar. SEMS may be an alternative to surgery with the advantage of early hospital discharge and lower risk of permanent stoma.

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Section: Introductionmentioning

confidence: 99%

Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis

et al. 2018

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“…In contrast, bariatric surgery provides the most effective and prolonged response, in terms of weight loss, with excellent control of obesity-associated comorbidities 9 10 11 12 13 . However, indications for bariatric surgery are quite specific and it is not without risks 7 14 15 .…”

Section: Discussionmentioning

confidence: 99%

“…During the evolution of IGB use, complications arose with the earlier, air-filled models, including leakage and migration of the device from the stomach into the small intestine, resulting in intestinal obstruction. Complications that are more serious, such as bleeding and gastric perforation, can also occur, especially during insertion or removal of the device 6 7 .…”

Section: Introductionmentioning

confidence: 99%

Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review

Barrichello

Ribeiro

Fittipaldi-Fernandez³

et al. 2018

Endosc Int Open

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Background and study aims Obesity is a serious disease, resulting in significant morbidity and mortality. Intragastric balloons (IGBs) have been in use since the 1980s. After the insertion of an IGB, complications such as migration of the device and even severe gastric perforation can occur, requiring laparoscopic surgery. Here, we report three cases of gastric perforation after IGB insertion. In all three cases, the perforation was successfully repaired through an exclusively endoscopic approach.

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“…Moreover, elevated DALs have been associated with leaks in bariatric surgery. Indeed, a high concentration of DALs after Roux-en-Y gastric bypass (RYGB) has been associated with gastrojejunal leak [12,13]. However as far as we are aware no studies have investigated the relationship between DALs and the appearance of a gastric leak after LSG.…”

Section: Introductionmentioning

confidence: 99%

Drain Amylase Levels in the Early Diagnosis of Gastric Leak after Laparoscopic Sleeve Gastrectomy

et al. 2021

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Highlights of the Study• Gastric leak is the most dreaded septic complication after sleeve gastrectomy.• With the advent of enhanced recovery after surgery (ERAS) protocols, the early detection of gastric leak following laparoscopic sleeve gastrectomy (LSG) is imperative. • The use of drain amylase levels to detect enteric or pancreatic leak has been described previously.• In this study, we have investigated the relationship between this index and the appearance of a gastric leak after LSG.

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Drain Amylase Levels May Indicate Gastrojejunostomy Leaks After Roux-en-Y Gastric Bypass

Abstract: The determination of drain amylase levels after RYGB was a significant indicator of leaks, hospital stay, and 30-day reoperations. This finding reinforces the importance of abdominal drainage in the RYGB within this context.

Cited by 13 publications

References 30 publications

Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis

Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis

Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review

Drain Amylase Levels in the Early Diagnosis of Gastric Leak after Laparoscopic Sleeve Gastrectomy

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