Endoscopic Stenting of Gastric Staple Line Leak Following Sleeve Gastrectomy

Abstract

Laparoscopic sleeve gastrectomy is known to be associated with a risk of gastric staple line leak. We report on our experience with endoscopic stenting of the anomalous leaking tract. Three cases of post sleeve gastric leak confirmed by computed tomography scan were treated by endoscopic stenting of their leak with a plastic endoprosthesis under fluoroscopic and endoscopic guidance. Endoscopic stenting by means of biliary or pancreatic endoprosthesis was successful in the three patients. The median number of endoscopy procedures per patient was 1.3. Stents were extracted 6 to 10 weeks after their placement. Neither morbidity nor recurrence was noticed on follow-up. Endoscopic stenting of gastric staple line leak following sleeve gastrectomy proved to be an efficacious technique for leak healing.

Results of Laparoscopic Sleeve Gastrectomy in 541 Consecutive Patients with Low Baseline Body Mass Index (30–35 kg/m2)

“…Notably, since the cost of 1-year follow-up visits was included in the initial package, patients were better motivated and only 2 % of patients were lost to follow-up at this point which compares favorably with other published reports [11,18,21]. Remarkably, this optimal BMI category is rarely obtained when LSG is performed on morbidely obese patients [21,22]. The elevated %EBMIL values in this study as compared to those of morbidely obese patients are explained by the relatively low baseline BMI Table 5 Mean weight (W), body mass index (BMI), body mass index loss (BML), percentage of total weight loss (%TWL) and percentage of excess body mass index loss (%EBMIL)) at each follow up [11,18,21].…”

“…Although LSG is technically attractive, the procedure is burdened by the risk of gastric leaks that occurred in up to 7 % of cases [12,22]. High gastric leak mechanisms are technically dependent occurring mostly during the initial experience (distal stenosis, inadequate stapling, laceration or thermal injury) or tissue-dependent occurring during the healing process.…”

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].…”

Endoscopic management of bariatric surgical complications

“…A novel approach using a cardiac septal occluder device (Amplatzer; St. Jude Medical, Plymouth, Minnesota, USA) has been described in a patient with a post sleeve gastrectomy leak and may be a suitable last resort in patients that fail other endoscopic attempts at closure [45]. Diversion therapy using esophageal SEMS achieves clinical success in 55-100% of patients, although multiple endoscopic sessions using multiple stents as well as other adjunctive therapies may be necessary [14,29,[46][47][48][49]. Optimal results are noted when esophageal SEMS are utilized for acute and early leaks with clinical response in more than 90% of patients ( Fig.…”