Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents

Klimczak, Tomasz; Klimczak, Jerzy; Szewczyk, Tomasz; Janczak, Przemysław; Jurałowicz, Piotr

doi:10.1007/s00464-017-5900-7

Cited by 31 publications

(18 citation statements)

References 12 publications

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“…Endoscopic stent implantation successfully treated GL in 69.6% of our patients. This result is consistent with published studies (success ranging from 65 to 100%) [9][10][11][12][13][14][15][16][17][18][19][20][21][22]32] and with systematic reviews (up to 87.8%) [33]. However, in cases where stent therapy was performed with a MS, the success rate was significantly higher (90.9 vs. 50.0% respectively, p = 0.006), which is also in line with the available literature [10-13, 15-20, 34-40].…”

Section: Discussionsupporting

confidence: 91%

“…facilitating rapid and effective treatment [9][10][11][12][13][14][15][16] and delivering success rates ranging from 67 to 100% [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Several studies have clearly demonstrated the advantages of stent therapy which include [23] (i) a reduction in the number of procedures/interventions required, including endoscopies and stent changes, (ii) earlier resumption of oral nutrition and (iii) a significant reduction in the duration of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

et al. 2021

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Purpose Gastric staple line leakage (GL) is a serious complication of laparoscopic sleeve gastrectomy (LSG), with a specific mortality ranging from 0.2 to 3.7%. The current treatment of choice is stent insertion. However, it is unclear whether the type of stent which is inserted affects treatment outcome. Therefore, we aimed not only to determine the effectiveness of stent treatment for GL but also to specifically clarify whether treatment outcome was dependent on the type of stent (small- (SS) or megastent (MS)) which was used. Patients and Methods A single-centre retrospective study of 23 consecutive patients was conducted to compare the outcomes of SS (n = 12) and MS (n = 11) for the treatment of GL following LSG. The primary outcome measure was the success rate of stenting, defined as complete healing of the GL without changing the treatment strategy. Treatment change or death were both coded as failure. Results The success rate of MS was 91% (10/11) compared to only 50% (6/12) for SS (p = 0.006). An average of 2.3 ± 0.5 and 6.8 ± 3.7 endoscopies were required to achieve healing in the MS and SS groups respectively (p < 0.001). The average time to resumption of oral nutrition was shorter in the MS group (1.4 ± 1.1 days vs. 23.1 ± 33.1 days, p = 0.003). Conclusions Stent therapy is only effective and safe for the treatment of GL after LSG if a MS is used. Treatment with a MS may not only increase treatment success rates but may also facilitate earlier resumption of oral nutrition and shorten the duration of hospitalization. Graphical Abstract

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

et al. 2021

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“…Despite the novel double bump design of the Beta stent, migration occurred in 32% of patients (in 5 patients endoscopic repositioning was possible) which remains comparable to migration rates in FCSEMS [65]. Similar high rates of migration were reported by Klimczak et al (46.1%) [67] and van Wezenbeek et al (66.7%) [66] utilizing bariatric specific stents. These findings of high migration rates in bariatric specific stents underscore that the experienced endoscopist may achieve clinical success not on the reliance of one intervention, but rather with a multimodality approach.…”

Section: Stents For Acute or Chronic Leakssupporting

confidence: 67%

Endoscopic therapeutic interventions for management of postoperative bariatric surgery complications

Westerveld

Sharaiha

2020

Techniques and Innovations in Gastrointestinal Endoscopy

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“…In the setting of worrisome clinical signs and normal imaging, laparoscopic or open operative exploration is warranted to rule out GI leak . Nonoperative methods of GI leak treatment after both RYGB or SG include endoscopic endoluminal self‐expandable stents, clips and sutures, endoscopic and percutaneously placed drains, and biologic glue/tissue sealants . Because length of hospital stay after bariatric surgery continues to decrease with the use of ERABS, some septic complications will occur after the relatively earlier hospital discharge .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

324

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents

Abstract: Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.

Cited by 31 publications

References 12 publications

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

Endoscopic therapeutic interventions for management of postoperative bariatric surgery complications

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