Endoscopy 2007; 39(7): 625-630
DOI: 10.1055/s-2007-966533
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery

P.  Eisendrath1 , M.  Cremer1 , J.  Himpens2 , G.-B.  Cadière3 , O.  Le Moine1 , J.  Devière1
  • 1Medical Surgical Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, Université libre de Bruxelles (U.L.B.), Brussels, Belgium
  • 2Department of Surgery for Morbid Obesity, St Blasius Hospital, Dendermonde, Belgium
  • 3Department of Digestive Surgery, St-Pierre Hospital, Université libre de Bruxelles (U.L.B.), Brussels, Belgium
Further Information

Publication History

submitted 29 June 2006

accepted after revision 29 December 2006

Publication Date:
24 September 2007 (online)

Background: Reoperations for complications of bariatric surgery are associated with high morbidity and mortality. It is not known whether endoscopic treatment may reduce reoperation rates.

Methods: Twenty-one patients underwent endoscopic treatment for persisting large anastomotic leaks before considering redo surgery. Eight patients had a gastric bypass, eight had a sleeve gastrectomy combined with a duodenal switch (SDS), four had a sleeve gastrectomy alone, and one had a Scopinaro procedure (biliopancreatic diversion). Fistulas were gastrocutaneous in 15 patients, duodenocutaneous in 2, gastroperitoneal in 3, and gastrobronchial in 1. Partially covered self-expanding metal stents (SEMSs) were used, followed by additional endoscopic procedures if the SEMS failed. SEMSs were removed by traction alone or by insertion of a self-expanding plastic stent (SEPS) followed by extraction of both stents together.

Results: SEMS insertion led to 62 % (13/21) primary closures. Complementary endoscopic treatment led to 4 secondary closures. Total success rate was 81 % (17/21). Three patients in whom SEMSs failed underwent reoperation but died during postoperative follow-up; one patient died from pulmonary embolism before SEMS extraction. The success rates of endotherapy were 100 % (8/8) in the gastric bypass group, 62.5 % (5/8) in the SDS group, 75 % (3/4) in the sleeve gastrectomy group, and 100 % (1/1) for the Scopinaro procedure. Gastrocutaneous fistulas on sleeve sutures were successfully treated in 60 % of cases (6/10), while other anastomotic fistulas were successfully treated in 100 % of cases (11/11) (P = 0.0351).

Conclusions: Endoscopic treatment using SEMSs for complications of bariatric surgery is feasible. Healing of severe leaks was obtained in 81 % (17/21) of patients, avoiding high-risk reintervention. Gastrocutaneous fistulas on a sleeve suture are the most difficult condition to treat.

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P. Eisendrath, MD

Medical Surgical Department of Gastroenterology and Hepatopancreatology

Erasme Hospital

Université libre de Bruxelles (U.L.B.)

808 route de Lennik

1070 Brussels

Belgium

Fax: +32-2-5556699

Email: peisendr@ulb.ac.be