Gastroesophageal stenting for the management of post sleeve gastrectomy leak

Abstract

ObjectivesTo retrospectively evaluate the effectiveness of gastroesophageal stenting for post sleeve gastrectomy staple line leaks using removable self-expandable stents.MethodsBetween April 2012 and June 2015, 12 consecutive patients (6 males) with mean age of 34 years: (21-38 years) presented with staple line leak 1-8 weeks after the operation (mean 2.8 weeks). Patients underwent gastroesophageal stenting by interventional radiology. A total of 23 stents were deployed with mean length of 17.8 cm (7-24 cm) and mean diameter 25.6 mm (18-36 mm). Stent re-insertion was needed in 7 patients (9 procedure), while 6 patients required percutaneous collection drainage and 3 patients required endoscopic glue injection with clipping. Two stent removal procedures were carried out under endoscopic visualization after failed stent capture under fluoroscopy, while the remaining stents were successfully removed by interventional radiology.ResultsStent placement was technically successful in all patients. Stent migration occurred in 6 patients (50%). There is a tendency for stent migration with shorter stent length (R= -0.557, p=0.008). The mean duration of stenting was 60.5 days (14-137 days). All patients underwent stent removal and resumed oral intake with no recurrence of leak at a mean follow up time of 190 days (14-410 days). Complications included gastrointestinal bleeding (n=1), proximal esophageal stricture (n=1) and stent occlusion (n=1).ConclusionGastroesophageal stenting as a primary measure after diagnosis of early post sleeve gastrectomy leak appears to offer a safe and effective alternative option in obviating repeat surgical interventions. Minimally invasive interventions may still be required for the management of persistent leak.

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

“…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 .…”

Endoscopic Management of Post-Laparoscopic Sleeve Gastrectomy Leakage and Stenosis Using Fully Covered Stent

“…[ 16 ] Guzaiz et al . [ 17 ] retrospectively evaluated the effectiveness of gastroesophageal stenting in six patients with post-LSG leak using removable SEMS and found that one patient developed esophageal stricture at the proximal stent margin 6 months after stent removal and was treated endoscopically with four quadrant incisions and balloon dilation. In a study by Shehab et al .,[ 18 ] where 62 patients with post-bariatric surgical leaks (of which 46 [73%] were post-LSG leaks) were treated with endoscopic placement of mega stent and/or over-the-scope clips, 8 patients (12.9%) developed stent-induced esophageal strictures, and all were successfully treated with endoscopic balloon dilation.…”

Endoscopía luego de cirugía bariátrica: Lo que debe saber el endoscopista

“…Nuestra preferencia es colocar stents parcialmente cubiertos con remoción/intercambio de rutina cada 2-3 semanas, antes que la mucosa crezca entre las ranuras y se haga más difícil el retiro. La migración del stent es de gran preocupación y se ha reportado hasta 50% de las aplicaciones, siendo la complicación más frecuente 57 .…”