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Internal endoscopic drainage as first line or second line treatment in case of postsleeve gastrectomy fistulas

Published on Jun 1, 2018in Endoscopy International Open
· DOI :10.1055/s-0044-101450
Jean-Michel Gonzalez9
Estimated H-index: 9
(AMU: Aix-Marseille University),
Diane Lorenzo4
Estimated H-index: 4
(AMU: Aix-Marseille University)
+ 2 AuthorsMarc Barthet36
Estimated H-index: 36
(AMU: Aix-Marseille University)
Sources
Abstract
Background and study aims Management of post-sleeve gastrectomy fistulas (PSGF) recently has evolved, resulting in prioritization of internal endoscopic drainage (IED). We report our experience with the technique in a tertiary center. Patients and methods This was a single-center, retrospective study of 44 patients whose PSGF was managed with IED, comparing two periods: after 2013 (Group 1; n = 22) when IED was used in first line and before 2013 (Group 2; n = 22) when IED was applied in second line. Demographic data, pre-endoscopic management, characteristics of fistulas, therapeutic modalities and outcomes were recorded and compared between the two groups. The primary endpoint was IED efficacy; the secondary endpoint was a comparison of outcomes depending on the timing of IED in the management strategy. Results The groups were matched in gender (16 female, 16 male), mean age (43 years old), severity of fistula, delay before treatment, and exposure to previous endoscopic or surgical treatments. The overall efficacy rate was 84 % (37/44): 86 % in Group 1 and 82 % in Group 2 (NS). There was one death and one patient who underwent surgery. The median time to healing was 226 ± 750 days (Group 1) vs. 305 ± 300 days (Group 2) (NS), with a median number of endoscopies of 3 ± 6 vs. 4.5 ± 2.4 (NS). There were no differences in number of nasocavity drains and double pigtail stents (DPS), but significantly more metallic stents, complications, and secondary strictures were seen in Group 2. Conclusion IED for management of PSGF is effective in more than 80 % of cases whenever it is used during the therapeutic strategy. This approach should be favored when possible.
  • References (26)
  • Citations (5)
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References26
Newest
#1Mati Shnell (TAU: Tel Aviv University)H-Index: 1
#2Nathan Gluck (TAU: Tel Aviv University)H-Index: 9
Last. Sigal Fishman (TAU: Tel Aviv University)H-Index: 18
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Background Staple-line leak following laparoscopic sleeve gastrectomy is a dire adverse event. While the treatment of acute and early leaks is well established, there is still dispute regarding late and chronic leaks. We describe an endoscopic approach combining septotomy and sleeve stricture dilation for treating late/chronic leaks. Methods Ten consecutive patients with late/chronic proximal leaks were treated at our center. The septum separating the sleeve lumen from the perigastric cavity was...
8 CitationsSource
#1Steven G. Leeds (Baylor University Medical Center)H-Index: 5
#2James S. Burdick (Baylor University Medical Center)H-Index: 5
Abstract Background Sleeve gastrectomy has become a popular weight loss procedure, but it is associated with staple line leak resulting in high morbidity and mortality. Current management options range from endoscopic techniques (predominantly stent placement) to surgical intervention. Objective The purpose of this study was to recognize endoluminal vacuum (E-Vac) therapy as a viable option for use in anastomotic leaks of sleeve gastrectomies. Setting This study took place at Baylor University M...
34 CitationsSource
#1Simon Bouchard (UdeM: Université de Montréal)H-Index: 4
#2Pierre Eisendrath (ULB: Université libre de Bruxelles)H-Index: 17
Last. Jacques Devière (ULB: Université libre de Bruxelles)H-Index: 79
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Background and study aims: Diverse endoscopic methods, such as placement of temporary self-expandable stents, have proven effective for the treatment of post-bariatric surgery leaks. However, some patients do not respond to the usual endoscopic treatment. This study tested the efficacy of an alternative treatment strategy based on trans-fistulary drainage with double-pigtail plastic stents. Patients and methods: We performed a retrospective analysis of patients with abdominal collections followi...
18 CitationsSource
#1Nathan Smallwood (Baylor University Medical Center)H-Index: 2
#2James W. Fleshman (Baylor University Medical Center)H-Index: 52
Last. James S. Burdick (Baylor University Medical Center)H-Index: 5
view all 4 authors...
Introduction Upper intestinal leaks and perforations are associated with high morbidity and mortality rates. Despite the growing experience using endoscopically placed stents, the treatment of these leaks and perforations remain a challenge. Endoluminal vacuum (E-Vac) therapy is a novel treatment that has been successfully used in Germany to treat upper gastrointestinal leaks and perforations. There currently are no reports on its use in the USA.
47 CitationsSource
Introduction The management of post-operative anastomotic leakage and fistulas of the upper GI tract remains challenging. Fully covered stents are used despite a high risk of migration because of a better removability. The goal of our study was to evaluate the effectiveness of this new type of endoscopic stent in this indication. The secondary objective was to determine the ability of withdrawing this stent.
14 CitationsSource
#1Gianfranco Donatelli (Sapienza University of Rome)H-Index: 5
#2Jean-Loup DumontH-Index: 7
Last. Bruno MeduriH-Index: 13
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Background Leaks are considered one of the major complications of laparoscopic sleeve gastrectomy (LSG) with a reported rate up to 7 %. Drainage of the collection coupled with SEMS deployment is the most frequent treatment. Its success is variable and burdened by high morbidity and not irrelevant mortality. The aim of this paper is to suggest and establish a new approach by endoscopic internal drainage (EID) for the management of leaks.
64 CitationsSource
#1Alberto Murino (ULB: Université libre de Bruxelles)H-Index: 2
#2Marianna Arvanitakis (ULB: Université libre de Bruxelles)H-Index: 19
Last. Pierre Eisendrath (ULB: Université libre de Bruxelles)H-Index: 17
view all 6 authors...
Background Endoscopic management of post-bariatric surgery leaks using self-expandable metal stents (SEMSs) is an alternative to revisional surgery. We evaluated the effectiveness of a standardized protocol for management of post-bariatric surgery leaks in a large cohort of patients.
26 CitationsSource
#1Pascale MerckyH-Index: 2
Last. Marc BarthetH-Index: 36
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Background and Aim Therapeutic endoscopy has recently evolved into the treatment of complex gastrointestinal (GI) postoperative leakage, especially with over-the-scope clips (OTSC). We describe our 2-year experience of 30 patients treated for digestive fistulas using the OTSC device. Methods This was a retrospective study conducted on patients referred for GI fistulas in two French hospitals. Technical aspects, clinical outcomes and closure rates were recorded. Results Thirty patients were treat...
49 CitationsSource
#1Carlos A. Puig (Mayo Clinic)H-Index: 5
#2Tarek M. Waked (Mayo Clinic)H-Index: 1
Last. Michael G. Sarr (Mayo Clinic)H-Index: 86
view all 6 authors...
Abstract Background The use of endoluminal stents has been proposed for the management of fistulas and anastomotic strictures after bariatric surgery. The objective of our study was to determine the success of endoscopically placed, self-expandable metal stents (SEMS) in bariatric patients specifically with either chronic persistent anastomotic or staple line leaks/fistulas or chronic, persistent anastomotic strictures. Methods We treated 21 patients including 5 with chronic staple line leaks/fi...
46 CitationsSource
#2Stefano FerrettiH-Index: 10
Last. Bruno MeduriH-Index: 13
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Background Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved.
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PURPOSE: Gastropleural and gastrobronchial fistulas (GPF/GBFs) are serious but rare complications after bariatric surgery whose management is not consensual. The aim was to establish a cohort and evaluate different clinical presentations and therapeutic options. MATERIALS AND METHODS: A multicenter and retrospective study analyzing GPF/GBFs after bariatric surgery in France between 2007 and 2018, via a questionnaire sent to digestive and thoracic surgery departments. RESULTS: The study included ...
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#1Iqbal Siddique (Kuniv: Kuwait University)H-Index: 15
#2Waleed Alazmi (Kuniv: Kuwait University)H-Index: 7
Last. Salman Al-Sabah (Kuniv: Kuwait University)H-Index: 11
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Abstract Background Leaks and fistulas after laparoscopic sleeve gastrectomy (SG) are a major adverse event of bariatric surgery. Endoscopic management for post SG leaks has evolved from closure with covered self-expanding metallic stents (SEMS) to endoscopic internal drainage (EID). Objective To report our experience with the management of post SG leaks treated with EID, either as primary therapy or after failure of closure therapy with SEMS. Setting Single-center observational study. Methods A...
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#1Salvador Machlab (Autonomous University of Barcelona)H-Index: 1
Last. Félix Junquera (ISCIII: Carlos III Health Institute)H-Index: 12
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Sleeve gastrectomy is currently the most frequently performed bariatric surgery. Postoperative leaks represent the main cause of morbidity in up to 8% of patients with a mortality rate ranging between 0.1 and 5%. However, management of these leaks remains controversial. We report the case of a patient presenting with sepsis 2 weeks after surgery. A subphrenic collection and a leak were found on CT. Despite medical treatment, the patient did not show clinical improvement. Hence, we considered a t...
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#1Phillip S. Ge (University of Texas MD Anderson Cancer Center)
#1Phillip S. GeH-Index: 8
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Endoscopic suturing allows for select patients with perforations, leaks, and fistulas to be managed endoscopically. Experience with the Overstitch endoscopic suturing device suggests it may be superior to endoclips in the management of perforations, because of its ability to achieve full-thickness suturing and create an airtight closure. Although successful closure of leaks and fistulas using the Overstitch device has been described, additional therapy with a multimodality approach is often requ...
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#1Diogo Moura (USP: University of São Paulo)H-Index: 4
#2Eduardo Guimarães Hourneaux de Moura (USP: University of São Paulo)H-Index: 12
Last. Christopher C. Thompson (Brigham and Women's Hospital)H-Index: 82
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Abstract Background The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. Objectives The aim of this study was to evaluate the safety and efficacy o...
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#1Antonio Giuliani (University of L'Aquila)H-Index: 4
#2Lucia Romano (University of L'Aquila)H-Index: 3
Last. Francesco Carlei (University of L'Aquila)H-Index: 19
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Abstract Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. Good results have been reported using endoscopic double-pigtail stent. To estimate its effectiveness, we carried out this systematic review. Eleven eligible articles were identified by searching PubMed, Embase, and Cochrane Library databases. A total of 385 patients met the inclusion criteria. The pooled proportion of successful leak closures by using double p...
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#1Alberto BiestroH-Index: 9
#2Diogo Moura (USP: University of São Paulo)H-Index: 4
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Background Endoscopy has evolved to become first-line therapy for the treatment of post-bariatric leaks; however, many sessions are often required with variable success rates. Due to these limitations, the use of the cardiac septal defect occluder (CSDO) has recently been reported in this population. Methods The study population was a multicenter retrospective series of patients with post-bariatric surgical leaks who underwent treatment with CSDO placement. Data on the type of surgery, previous ...
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#1Diogo Moura (Harvard University)H-Index: 4
#2Amit H. Sachdev (Harvard University)H-Index: 7
Last. Christopher C. Thompson (Harvard University)H-Index: 82
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Purpose of Review Gastrointestinal transmural defects are defined as total rupture of the gastrointestinal wall and can be divided into three main categories: perforations, leaks, and fistulas. Due to an increase in the number of therapeutic endoscopic procedures including full-thickness resections and the increase incidence of complications related to bariatric surgeries, there has been an increase in the number of transmural defects seen in clinical practice and the number of non-invasive endo...
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