Gastroesophageal Junction Leak with Serious Sepsis after Gastric Bypass: Successful Treatment with Endoscopy-Assisted Intraluminal Esophageal Drainage and Self-expandable Covered Metal Stent

Martín-Malagón, Antonio; Arteaga-González, I J; Rodriguez-Ballester, Lucrecia; Díaz-Romero, Francisco

doi:10.1007/s11695-009-9978-4

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…An intraluminal covering stent has been shown to be a successful treatment for esophageal rupture in AL after gastric bypass or esophageal cancer surgery 6‐8 . Covering colon stents have been tested in AL after colon surgery, and the preliminary results seem promising 9‐12 .…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Very recently, covered intraluminal stents have been successfully introduced to manage AL after oesophagectomy, gastric bypass, and gastric sleeve operations. [6][7][8] However, there are only a few clinical case reports and an animal study that describe the use of covered stents in colorectal AL. [9][10][11][12] Intraperitoneal microdialysis (IPM) has been introduced as a promising method for the prediction of surgical complications after gastrointestinal surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Intraluminal covering stents are being used as a nonoperative alternative for the treatment of benign and malignant strictures in the gastrointestinal tract 4,5 . Very recently, covered intraluminal stents have been successfully introduced to manage AL after oesophagectomy, gastric bypass, and gastric sleeve operations 6‐8 . However, there are only a few clinical case reports and an animal study that describe the use of covered stents in colorectal AL 9‐12 …”

Section: Introductionmentioning

confidence: 99%

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Fully covered self‐expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent

et al. 2022

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Background and Aim Anastomotic leakage (AL) in colorectal resection and primary anastomosis is a common and feared complication. Fully covered self‐expandable metal stents (FCSEMSs) have been used for the treatment of AL. It is still unknown whether FCSEMSs affect anastomosis healing negatively by causing ischemia. In an animal study, we investigated the metabolic effects over a FCSEMS covering a stapled colon anastomosis. Methods Seven pigs were investigated using microdialysis after laparotomy, colon resection, and anastomosis with stent placement. Measurements were done at the proximal and distal ends of the anastomosis and at a reference catheter placed at the small intestine. Measurements of glucose, pyruvate, lactate, glycerol, and the lactate/pyruvate ratio (L/P) were carried out. Results Lactate and L/P were significantly higher at the oral part of the anastomosis, while glucose showed a small declining tendency. At the distal part of the anastomosis, glucose decreased significantly after the resection but did not reach zero. Lactate increased significantly whereas L/P increased only slightly. Glycerol levels were stable. Conclusion Colon resection caused initially hypermetabolism in the intestinal ends next to the resection site. This hypermetabolism neither deteriorated nor turned into ischemia during the initial postoperative course, but the start of hypoxemia could not be excluded during the study and after the placement of an FCSEMS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fully covered self‐expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent

et al. 2022

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“…Alternatively, a renewal of the gastrojejunostomy may be performed [7]. However, with the development of modern endoscopic devices such as covered stents and over-the-scope clips (OTCs), new therapeutic options have become available, but experience with these devices is still limited [8,9,10,11]. Therefore, we retrospectively analyzed the outcome of patients who developed a leak at the gastrojejunal anastomosis after LRYGB and compared the results of surgical and endoscopic treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Successful Endoscopic Management of Gastrointestinal Leakages after Laparoscopic Roux-en-Y Gastric Bypass Surgery

Schiesser¹,

Kressig²,

Bueter³

et al. 2014

Dig Surg

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Background: Management of leakages of the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB) can be complex. New endoscopic techniques such as covered stents and over-the-scope clips (OTCs) have been developed and are valuable alternative therapeutic options to reoperation and drainage. The aim of this study was to compare the value of stents and OTCs with surgical treatment options for the therapy of anastomotic leakages after LRYGB. Methods: Results of patients who were treated surgically with reoperation, local irrigation and drain placement (n = 9) were compared with results of patients who were treated endoscopically with stent and/or OTC placement (n = 5). Success rate, length of hospital stay, mortality, number of OTC applications/stent placement and percutaneous drainage placements were analyzed. Results: Overall, 14 of 1,046 patients (1.34%) developed a leakage of their gastrojejunal anastomosis after LRYGB between 2000 and 2012. While the success rate in surgically treated patients was 88%, the endoscopic treatment using a sequential approach with stenting, OTC application and percutaneous placement of drainages resulted in a 100% closure rate. The mortality rate and length of stay were not substantially different after both treatment regimens. Conclusion: Endoscopic management of anastomotic leakages after LRYGB may constitute a valuable alternative therapeutic option to surgical reoperation and drainage placement.

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“…Bariatric surgery is an invasive procedure associated with few complications in expert hands, but fistula and dehiscence may occur [1][2][3]. Reoperation often is required but results in significant morbidity.…”

Section: Introductionmentioning

confidence: 99%

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

et al. 2011

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Background Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. Methods A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb. Results Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total clousure of the fistula was reported 30 days afterward. Conclusions Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.

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Gastroesophageal Junction Leak with Serious Sepsis after Gastric Bypass: Successful Treatment with Endoscopy-Assisted Intraluminal Esophageal Drainage and Self-expandable Covered Metal Stent

Cited by 5 publications

References 14 publications

Fully covered self‐expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent

Fully covered self‐expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent

Successful Endoscopic Management of Gastrointestinal Leakages after Laparoscopic Roux-en-Y Gastric Bypass Surgery

Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass

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