Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent

Abstract

Background and study aim Leakage of the surgical suture is the main complication of laparoscopic sleeve gastrectomy (LSG) and is amenable to endoscopic therapy. The aim of this study was to evaluate the efficacy of a specifically designed self-expandable metal stent (SEMS) to seal the leakage.

Patients and methods Over a 2-year period, patients referred for the treatment of post-LSG fistulas underwent placement of a fully covered esophagogastric SEMS with a specific design.

Results A total of 10 patients were treated after a mean time of 50.9 days from the diagnosis of post-LSG leakage. A total of 11 SEMSs were placed. After stent removal, the leakage was seen to have healed in eight patients. Two patients who were treated with an SEMS with different mesh design, experienced stent migration, which required alternative endoscopic treatment such as the insertion of double-pigtail stents. After a mean follow-up period of 13.4 months, all patients were asymptomatic.

Conclusions: Placement of a specifically designed SEMS for the treatment of post-LSG fistulas seems a promising first-line therapy according to this small series.

• References

• 1 Rosenthal R, Diaz AA. International Sleeve Gastrectomy Expert Panel. et al. International Sleeve Gastrectomy Expert Panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2012; 8: 8-19
• 2 Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol 2014; 20: 13904-13910
• 3 Christophorou D, Valats J, Funakoshi N. et al. Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study. Endoscopy 2015; 47: 988-996
• 4 Keren D, Eyal O, Sroka G. et al. Over-the-scope clip (OTSC) system for sleeve gastrectomy leaks. Obes Surg 2015; 25: 1358-1363
• 5 Tringali A, Daniel F, Familiari P. et al. Endoscopic treatment of a recalcitrant esophageal fistula with new tools: stents, Surgisis, and nitinol staples (with video). Gastrointest Endosc 2010; 72: 647-650
• 6 Surace M, Mercky P, Demarquay J. et al. Endoscopic management of GI fistulae with the over-the-scope clip system (with video). Gastrointest Endosc 2011; 74: 1416-1419
• 7 Mercky P, Gonzalez J, Aimore Bonin E. et al. Usefulness of over-the-scope clipping system for closing digestive fistulas. Dig Endosc 2015; 27: 18-24
• 8 Shehab H, Hakky S, Gawdat K. An endoscopic strategy combining Mega stents and Over-The-Scope Clips for the management of post-bariatric surgery leaks and fistulas (with video). Obes Surg 2016; 26: 941-948
• 9 van Wezenbeek M, de Milliano M, Nienhuijs S. et al. A specifically designed stent for anastomotic leaks after bariatric surgery: experiences in a tertiary referral hospital. Obes Surg 2016; 26: 1875-1880
• 10 Donatelli G, Dumont J, Cereatti F. et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 2015; 25: 1293-1301
• 11 O’Connor L, Champagne B, Ferguson M. et al. Efficacy of anal fistula plug in closure of Crohn’s anorectal fistulas. Dis Colon Rectum 2006; 49: 1569-1573
• 12 O’Riordan J, Datta I, Johnston C. et al. A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum 2012; 55: 351-358