Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for Treatment of Leaks Following Sleeve Gastrectomy

Abstract

EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required.

ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management

“…Stenting may allow the patient to support their own nutritional needs with oral feeding during the healing process, potentially decreasing the overall duration of treatment [59]. The majority of patients treated with an endoluminal stent achieve complete healing with a success rate of 55-100% [58][59][60]63,83,98,[100][101][102][103][104][105][106][107][108][109][110][111][112]. Stenting often requires multiple endoscopies for stent replacement, or for the addition of other endoscopic adjuncts, over the course of treatment [59,101,106,108,113].…”

“…An internal drain placed endoscopically through the staple line dehiscence may effectively control local sepsis by draining a perigastric abscess, promote resorption of fluid, enhance healing, and avoid the formation of an external fistula. Internal drainage strategies often require multiple endoscopies, drain replacements, and other adjuncts, however, to achieve complete healing [101,108]. Interest in biological glue has grown from case reports of successful treatment of gastrointestinal fistulae with fibrin glue injection.…”

Management of Distal Gastric Leak After Laparoscopic Sleeve Gastrectomy by Double Pigtail Catheter

“…Inspired by the success of endoscopic internal drainage for the management of pseudocysts in chronic pancreatitis, Pequignot et al became the first researchers to explore the use of DPC for GL management after LSG [3]. In a study of the efficacy of endoscopic internal drainage coupled with enteral nutrition via nasojejunal catheter,Donatelli et alreported a 95.2% success rate (20/21 patients)in GL management after LSG [9]. However, 66% (14/21) of the patients needed repeated endoscopic sessions and 42.8% (9/21) needed additional OTSCs.…”

Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy

“…Finally, we opted for treatment with EID alone, when possible, in cases of limited perigastric collection. When used exclusively, EID was coupled with enteral nutrition via insertion of a nasojejunal feeding tube [22]. Patients were kept fasting and underwent systematic endoscopic control after 3 weeks Q5 .…”