Endoscopy 2018; 50(04): S56
DOI: 10.1055/s-0038-1637193
ESGE Days 2018 oral presentations
20.04.2018 – Bariatric endoscopy
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MANAGEMENT OF THE POST-OPERATIVE LEAKS AFTER A BARIATRIC SURGERY

G Claudé
1   CHU Besancon, Besancon, France
,
B Vedrenne
2   Clinique du Diaconat, Mulhouse, France
,
T Degand
3   CHU Dijon, Dijon, France
,
P Claudé
4   CHR Mulhouse, Mulhouse, France
,
JB Chevaux
5   CHU Nancy, Nancy, France
,
L Vuitton
1   CHU Besancon, Besancon, France
,
S Koch
1   CHU Besancon, Besancon, France
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

The number of bariatric surgeries increased in the past decades. Post-surgical leaks are a major complication of these procedures. The endoscopic strategies of treatment have proven their efficiency, initially using self-expendable metal stents to cover the fistula tract in association with a surgical or radiological drainage. An endoscopic internal drainage using double pigtails stents seemed to be as efficient and better tolerated. The primary aim of this study was to evaluate the efficiency of the endoscopic management and the secondary aims were to evaluate the efficacy of the endoscopic internal drainage, to determine factors associated with a successful treatment.

Methods:

We performed a retrospective multicenter analysis of patients with post-bariatric gastric leaks treated by endoscopic management, between August 2009 and May 2017. The clinical success was the primary endpoint, defined by endoscopic or radiological confirmation of leak closure associated with a recovering of clinical state.

Results:

55 patients were included, 7 men/48 women, mean age 38 [SD 11,82], 50 had a sleeve gastrectomy and 5 a gastric by-pass. 25 patients had an endoscopic internal drainage. 44 patients (80%) were successfully treated. The success rate was higher for the patients who weren't internally drained with 28/30 patients (93%), versus 16/25 (64%), p = 0,02. However, the patients internally drained in the first ten days after the diagnosis of fistula, comparatively to the patients internally drained after the tenth day, had a better success rate (11/11 patients, 100%, versus 4/14 patients, 36%, p < 0,05) and a shorter healing time (79 versus 165 days, p = 0,02). 42/107 SEMS (39.25%) and 1 double pigtail stent migrated.

Conclusions:

This study confirms the success rates in the literature of the endoscopic management of the post-operative leaks after a bariatric surgery. The internal drainage is safe and gives better results when it is done early after the diagnosis of the leak.