Abstract
Introduction
Endoscopic stenting has been shown to be effective in treating leaks after bariatric surgery. However, concerns remain regarding its long-term efficacy. The purpose of this study was to assess the evolution of endoscopic stenting and its efficacy over time, as well as the impact of stent fixation on migration rates and long-term outcomes. In addition, the effect of stenting on long-term weight loss and chronic reflux was also evaluated.
Methods
A retrospective review was conducted including 37 patients from 2005 to 2017 who had undergone placement of stents after various bariatric procedures. Stents were placed endoscopically and, after 2012, secured with a figure-of-eight overstitch. Demographics, weight loss data, stent migration rates, incidence of revision surgery, chronic PPI use, and chronic symptoms of reflux data were obtained and analyzed.
Results
Thirty-seven patients from 2005 to 2017 required endoscopic stenting for leaks. 43.24% patients underwent sleeve gastrectomy, 40.54% gastric bypass, 5.40% patients underwent duodenal switch, and 10.81% underwent miscellaneous foregut procedures. The overall success rate was 94.59% (35 of 37 patients). The incidence of stent migration before 2012 was 41.18% versus 15% after 2012 (p = 0.136271). There were 2 treatment failures, one treated successfully with re-stenting and another other requiring revision surgery. Overall, the percent of excess body weight lost was 57.21% over an average of 21 months. 58.82% of patients used PPI chronically; however 41.17% noted actual symptoms of reflux. 16.22% (6 of 37) patients ultimately underwent revision surgery.
Conclusion
Endoscopic stenting is a safe and effective treatment for leaks after bariatric surgery. While complications can include stent migration, newer stent technology and endoscopic overstitching techniques show promise in reducing the incidence of stent migration. Despite undergoing treatment with stenting, these patients had successful weight loss with relatively low rates of chronic PPI use and reflux symptoms.
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References
Panot Y, Heneghan H, Tariq N, Brethauer S, Kroh M, Chand B (2011) Endoscopic stent management of leaks and anastomotic strictures after foregut surgery. Surg Obesity Relat Dis 7:628–636
Chang J, Sharma G, Boules M, Brethauer S, Rodriguez J, Kroh M (2016) Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques. Surg Obesity Relat Dis 12:1373–1381
Fukumoto R, Orlina J, McGinty J, Teixeira J (2007) Use of Polyflex Stents in treatment of acute esophageal and gastric leaks after bariatric surgery. Surg Obesity Relat Dis 3:68–72
Joo MK (2017) Endoscopic approach for major complications of bariatric surgery. Clin Endosc 50(1):31–41
Salinas A, Baptista A, Santiago E, Antor M, Salinas H (2006) Self-expandable metal stents to treat gastric leaks. Surg Obesity Relat Dis 2(5):570–572
Southwell T, Lim TH, Ogra R (2016) Endoscopic therapy for treatment of staple line leaks post-laparoscopic sleeve gastrectomy (LSG): experience from a large bariatric surgery centre in New Zealand. Obes Surg 26(6):1155–1162
Garofalo F, Noreau-Nguyen M, Denis R, Atlas H, Garneau P, Pescarus R (2017) Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partial covered to long, fully covered stents. Surg Obesity Relat Dis 13(6):925–932
Eubanks S, Edwards CA, Fearing NM, Ramaswamy A, de la Torre RA, Thaler KJ, Miedema BW, Scott JS (2008) Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg 206(5):935–938
Shehab H, Emad A, Gawdat K, Elattar I (2018) Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg 28:15–24
Donatelli G, Dumont JL, Cereatti F, Ferretti S, Vergeau BM, Tuszynski T, Pourcher G, Tranchart H, Mariani P, Meduri A, Catheline JM, Dagher I, Fiocca F, Marmuse JP, Meduri B (2015) Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 25(7):1293–1301
Leeds SG, Burdick JS (2016) Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obesity Relat Dis 12(7):1278–1285
Nedelcu M, Manos T, Cotirlet A, Noel P, Gagner M (2015) Outcome of leaks after sleeve gastrectomy based on a new algorithm assessing leak size and gastric stenosis. Obes Surg 25:559–563
Vargas E, Abu Dayyeh BK (2018) Keep calm under pressure: a paradigm shift in managing post-surgical leaks. Gastrointest Endosc 87(2):429–437
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Varun Krishnan, Kevin Hutchings, Andrew Godwin, Jonathan Wong, and Julio Teixeira have no conflicts of interest or financial ties to disclose.
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Krishnan, V., Hutchings, K., Godwin, A. et al. Long-term outcomes following endoscopic stenting in the management of leaks after foregut and bariatric surgery. Surg Endosc 33, 2691–2695 (2019). https://doi.org/10.1007/s00464-018-06632-7
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DOI: https://doi.org/10.1007/s00464-018-06632-7