Stent Management of Leaks After Bariatric Surgery: a Systematic Review and Meta-analysis

Abstract

BACKGROUND Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results. METHODSWe performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality. RESULTSA meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89 % (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65 % (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54 % (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's value of 1.0. No deaths were caused directly by complications with the stent placement. CONCLUSION Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.

Management of Leak by Intraoperative Megastent Insertion During Revisional Bariatric Metabolic Surgery: a Case Report

“…Endoscopic treatment for leaks after BMS has gained popularity over time [ 1 , 2 ]. Endoscopic stenting is one of the methods for treating post-bariatric surgery leaks, with a 92% success rate in SG and 96% in RYGB [ 1 ].…”

“…Endoscopic treatment for leaks after BMS has gained popularity over time [ 1 , 2 ]. Endoscopic stenting is one of the methods for treating post-bariatric surgery leaks, with a 92% success rate in SG and 96% in RYGB [ 1 ]. Stents have downsides such as reflux, chest pain, ulcers, bleeding, nausea, vomiting, and, notably, stent migration (23% rate for all procedures).…”

“…A recent meta-analysis of studies on self-expandable metallic stents (SEMS) covering 488 patients revealed an 85.89% (95% CI, 82.52–89.25%) success rate in leak closure. No deaths were directly linked to stent placement, underscoring the method’s safety and effectiveness [ 1 ].…”