The Use of Endoscopic Stent in Management of Leaks After Sleeve Gastrectomy

Abstract

Gastric leak after sleeve gastrectomy can lead to significant morbidity and mortality. The aim of this study was to examine the safety and efficacy of endoscopic deployment of a covered esophageal stent in the management of leaks after sleeve gastrectomy. Three consecutive patients who underwent sleeve gastrectomy at outside institutions presented with leaks. All three patients underwent endoscopic placement of a covered stent. Additional procedures included laparoscopic or percutaneous drainage of abdominal collection(s). The patients were two women and one man, with a mean age of 34 years. One patient presented acutely at day 7 after the index operation and two patients presented late at 6 and 9 months, respectively. Two patients had proximal gastric leaks and one patient had a proximal gastric leak with a concomitant obstruction at the mid-aspect of the gastric sleeve. Endoscopic deployment of a covered stent was successful in all cases. There were no complications relating to the stent placement. The stent was removed at 6 weeks in two patients and at 4 months in one patient. The use of endoscopic stent was a safe and effective option in the management of leaks after sleeve gastrectomy.

Endoscopic stenting for laparoscopic sleeve gastrectomy leaks

“…Covered self-expandable metallic stents have gained popularity in the management of leaks with variable results (5)(6)(7)(8)(9)(10)12). In our study, we obtained complete closure of the leaks by using variable length SECS.…”

Splenic abscess secondary to sleeve gastrectomy leak

“…In addition, adequate drainage of any abdominal collection is of utmost importance. [7] Parenteral nutrition or jejunostomy feeding is important for nutritional support, while oral feeding is withheld.…”

Endoscopic management of postoperative fistulas and leaks

“…Stent placement is effective for leaks after sleeve gastrectomy as well. 62,63 Stent placement for leaks in the lower GI tract in a challenging endeavor. The increased motility of lower GI tract causes stent migration both distally and proximally.…”