Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review

Shoar, Saeed; Poliakin, Lauren; Khorgami, Zhamak; Rubenstein, Rebecca; El-Matbouly, Moamena; Levin, Jun L.; Saber, Alan A.

doi:10.1007/s11695-017-2651-4

Cited by 72 publications

(33 citation statements)

References 44 publications

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“…Stenting of chronic leaks is much less effective with varied success rates ranging from 19 % to 81 % [14,15]. Endoscopic closure of leaks with over-the-scope clip sys-tems can be successful up to 86 % of the time, but success rates are much lower in cases of chronic leaks due to difficulty approximating fibrous tissue [16]. We believe that the same limitations apply to novel endoscopic suturing devices.…”

Section: Discussionmentioning

confidence: 98%

Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

et al. 2020

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Background and study aims Sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world. Leaks are the most feared complications after this procedure. Endoscopic septotomy has been described as a resolution technique that could be useful in the setting of late and chronic leaks. We present our experience in the management of gastric leaks with this advanced endoscopic technique. Patients and methods Retrospective review of patients who have been admitted to our hospital from January 2016 to December 2018. Results Five patients were found. All had their index surgery in outside hospitals. The average age was 51 years (range 40 – 69), and four patients were female. Mean time from LSG to leak presentation was 15 days (range 7 – 25). Mean time from leak presentation to septotomy procedure was 61 days (range 21 – 110). All patients were treated with sleeve dilatation before septotomy using endoscopic achalasia balloons. Mean procedure time was 79 minutes (range 55 – 125). Success was achieved in 80 % of patients, and no complications related to the procedure were identified. One patient underwent total gastrectomy for definitive management. Mean follow-up time was 14.25 months (range 6 – 26), and the average time for fistula closure was 60.25 days. Conclusion Endoscopic septotomy is safe and effective for management of chronic leaks after LSG. Associated non-selective dilatation may be a crucial step to allow distal patency and axis rectification for appropriate leak closure.

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Section: Discussionmentioning

confidence: 98%

Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

et al. 2020

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“…The overall successful closure was achieved in 67% of patients. In the previously published systematic review, 86.3% of patients treated with the OTSC system had an overall successful leak/fistula closure [15]. However, it included studies with concomitant or previous additional endoscopic procedures such as stent placement.…”

Section: Discussionmentioning

confidence: 99%

“…There are no prospective, randomized studies on this topic. Meta-analyses and systemic reviews on this topic are also limited [13][14][15].…”

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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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“…Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide (1) and it is known as a safe procedure with a low complication rate. Some of these complications, as the staple line leaks, can cause prolonged morbidity (2).…”

Section: Introductionmentioning

confidence: 99%

“…Some of these complications, as the staple line leaks, can cause prolonged morbidity (2). Various treatment options for gastric leaks have been described (1)(2)(3). Management of LSG sleeve leaks is difficult and complicated, and treatment options range from nonoperative management and endoscopic stenting to definitive reconstructive operations.…”

Section: Introductionmentioning

confidence: 99%

Roux-en-Y Feeding Jejunostomy - The Preferred Surgical Option for Enteral Nutrition in Patients with Leaks or Fistula after Gastric Sleeve

Copăescu¹,

Smeu²,

Habibi³

2019

chr

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Roux-en-Y Feeding Jejunostomy-The Preferred Surgical Option for Enteral Nutrition in Patients with Leaks or Fistula after Gastric Sleeve Chirurgia, 114 (6), 2019 www.revistachirurgia.ro 799 caracteristicile medicale ale pacienţilor, dificultăţile tehnice ale procedurii şi rezultatele acestora. Rezultate: Şase pacienţi (4 femei şi 2 bărbaţi, vârsta medie 37.1 ± 11.5 ani) cu gastrectomie longitudinală laparoscopică (gastric sleeve) au fost referiţi către spitalul nostru după ce drenajul iniţial al fistulei a fost efectuat în alte unităţi medicale, efectuându-se în centrul nostru jejunostomia laparoscopică pe ansa în Y "a la Roux". Timpul operator mediu a fost de 127.5 ± 61.2 minute. Durata medie a menţinerii jejunostomiei a fost de 183.83 ± 128.2 zile. Nu a existat mortalitate asociată. Fistulo-jejunostomia laparoscopică a fost tratamentul definitiv pentru cinci pacienţi (83.3%) în timp ce, la al şaselea pacient fistula s-a vindecat spontan. Concluzii: Suportul nutriţional adecvat este obligatoriu în tratamentul fistulei după gastric sleeve. Jejunostomia laparoscopică pe ansa în Y "a la Roux" are multe avantaje faţă de sonda naso-jejunală sau jejunostomia pe ansa continuă, mai ales pentru tratamentul fistulelor gastrice cronicizate. Experienţa noastră demonstrează că jejunostomia laparoscopică pe ansa în Y "a la Roux" poate fi implementată în siguranţă în varianta tehnică pe care o descriem. Cuvinte cheie: nutriţie enterală, jejunostomia de alimentaţie pe ansa în Y a la Roux, dehiscenţa, fistule, gastrectomie longitudinală

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Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review

Cited by 72 publications

References 44 publications

Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

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

Roux-en-Y Feeding Jejunostomy - The Preferred Surgical Option for Enteral Nutrition in Patients with Leaks or Fistula after Gastric Sleeve

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