ADVANCED ENDOSCOPIC MANAGEMENT OF SEVERE, COMPLEX BARIATRIC SURGERY COMPLICATIONS

Aims:

The aim of this study was to evaluate the success, safety and complications rates of advanced endoscopy for the management of bariatric surgery complications.

Methods:

Retrospective, observational cohort study at a single tertiary, referral, academic institution during a 36-month period evaluating patients with severe and complex post-bariatric surgery complications. Anastomotic stenosis were excluded.

Results:

During the study period we treated a total of 31 severe complications in 28 patients (mean age 55 years; 19 female, 9 male) with various types of complications directly related to obesity surgery: laparoscopic band or mesh migration into the stomach (n = 5), fistula (n = 13), abscess (n = 5), perforation due to stent migration in gastric sleeve (n = 1), and severe GI bleeding (n = 7). Underlying surgeries included: Roux-en-Y gastric (n = 16), gastric sleeve (n = 7), lap band (n = 5). With the exception of patients undergoing lap band removal, closure of fistula or perforation mandated the use of several devices such as over-the-scope-clip, suturing devices, glues, endosponge and stent in the remaining patients (n = 20). Seven patients underwent placement of a direct endoscopic jejunostomy (DPEJ) using balloon-overtube-assisted enteroscopy. Most patients required repeated endoscopies (range 1 – 7, median 4 procedures) to treat their complication. Endoscopy led to a full resolution of the primary problem in 54% of patients, partial resolution in 28.6% and no resolution in 17.8%. There were no serious adverse events associated with endoscopic interventions. One patient died of multi-organ failure as a result of a huge fistula associated with gastric sleeve leak.

Conclusions:

Advanced endoscopic interventions resulted in resolution or improvement of the bariatric complication in 3/4 of patients. However, some luminal defects associated with these types of surgery are recalcitrant to endoscopic approaches. Nevertheless, endoscopy can serve as a bridge to surgery, to partial close the defect, decrease the size of abscess, and provide enteral feeding, thus improving the patient's general status and outcome.