Outcome and Adverse Events of Endoscopic Bariatric Stents for Management of Leakage after Bariatric Surgery

Hamed, Hosam; Said, Mohammed El; Elghadban, Hosam; Elgeidie, Ahmed

doi:10.1007/s11695-019-04373-7

Cited by 11 publications

(8 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Endoscopic stenting is a minimally invasive procedure that allows early ambulation, enteral feeding, and greater patient comfort. 11 Fully covered self-expanding metal stents (SEMSs) are preferred for the management of SLLs. SEMSs have been the subject of a few meta-analyses in recent years.…”

Section: Stent Placementmentioning

confidence: 99%

Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective

Chung¹,

Park²,

Kim³

2021

Clin Endosc

View full text Add to dashboard Cite

Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1%-6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized. Clin Endosc 2021 May 12.

show abstract

Section: Stent Placementmentioning

confidence: 99%

Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective

Chung¹,

Park²,

Kim³

2021

Clin Endosc

View full text Add to dashboard Cite

show abstract

“…17 Hamed et al recently reported 73.3% clinical success with a 17.8% migration rate. 12 This study has shown 85.7% (six of seven patients: four patients with single SEMS, two with two SEMS) success rate with SEMS with a 14.3% migration rate.…”

Section: Discussionmentioning

confidence: 57%

“…Endotherapy for post LSG leaks is a minimally invasive therapeutic option with early ambulation, short hospitalization and allows initiation of enteral feeding. 11,12 The development of post LSG leaks is attributed to gastric wall ischemia, increased intraluminal pressure due to low compliance of gastric sleeve, and stenosis of the sleeve. 10,13 After placement of SEMS, intraluminal pressure will be reduced and enteral nutrition can be allowed as stent will bypass the leak and aids in healing.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Postlaparoscopic Sleeve Gastrectomy Leaks: A Single-Center Experience

Jagtap

Yashavanth

Kalapala

et al. 2020

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Sleeve leak is the most important complication, with an incidence of 1.9 to 2.4%. Various endoscopic approaches to LSG have been used, including self-expanding metal stents (SEMSs), glue injection, and clipping along with percutaneous drainage. This study was aimed to study the role of endotherapy in the management of post-LSG leaks. Methods This study included patients referred for endotherapy for post-LSG leak between January 2016 and December 2018. We maintained data prospectively, which included the location and type of leak, type of endotherapy, adverse events, and time for leak closure. Primary endotherapy included mega SEMS placement; if it failed, then secondary endoscopic therapy was performed. Results Seven patients (four females, with a mean age of 45.2 years) with a preoperative body mass index of mean 38.5 kg/m2 underwent endotherapy for post-LSG leaks. Two were acute, four were early, and the remaining one was late leak. Five were located proximally near gastroesophageal junction and two at the midsleeve level. In four (57.1%) patients, the leak was resolved by primary therapy. Three patients underwent secondary therapy that included overlapping SEMS placement (in one patient), SEMS replacement (in one patient), and short plastic biliary stent placement with Argon plasma coagulation (APC) to create a raw surface and induce granulation tissue. The median duration for leak closure was 12 weeks (range: 8–24 weeks). One patient who had partial distal migration underwent overlapping SEMS placement. Three patients had nonbleeding ulcers at the distal end of SEMS at removal. Conclusion Endotherapy is effective and safe for the management of post-LSG leaks. Additional endotherapy can be used if primary therapy is not successful for resolution of the leak.

show abstract

“…As part of a larger series, Moon et al reported 80.5% resolution (70/87 patients) of leaks (33 RYGB; 50 LSG; 4 other) with the deployment of FCSEMS, PCSEMS, and plastic endoscopic stents [54]. Indeed high variability of clinical success rates exists in the literature (65%-95%) [55,56] due to the variability of stent design. However, in their meta-analysis Okazaki et al suggests an overall stent success rate of 72.8% (187 patients; 24 studies) and 76.1% (108 patients; 11 studies) in post-LSG and RYGB leaks, respectively [57].…”

Section: Stents For Acute or Chronic Leaksmentioning

confidence: 99%

“…Since its introduction in 2006, stent design and composition has continued to evolve to alleviate the associated adverse events and limitation. Less commonly, ulcers [55], reflux [56], gastrointestinal bleeding and erosions [58] have all been described in the literature. Yet, the most notable adverse event remains stent migration ranging between 6% and 15% of PCSEMS [48,49], and 40% to 59% of FCSEMS [59][60][61].…”

Section: Stents For Acute or Chronic Leaksmentioning

confidence: 99%

Endoscopic therapeutic interventions for management of postoperative bariatric surgery complications

Westerveld

Sharaiha

2020

Techniques and Innovations in Gastrointestinal Endoscopy

View full text Add to dashboard Cite

Outcome and Adverse Events of Endoscopic Bariatric Stents for Management of Leakage after Bariatric Surgery

Cited by 11 publications

References 30 publications

Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective

Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective

Endoscopic Management of Postlaparoscopic Sleeve Gastrectomy Leaks: A Single-Center Experience

Endoscopic therapeutic interventions for management of postoperative bariatric surgery complications

Contact Info

Product

Resources

About