Skip to main content
Erschienen in:

04.01.2020 | Original Contributions

Outcome and Adverse Events of Endoscopic Bariatric Stents for Management of Leakage after Bariatric Surgery

verfasst von: Hosam Hamed, Mohammed Said, Hosam Elghadban, Ahmed Elgeidie

Erschienen in: Obesity Surgery | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Bariatric leakage (BL) is a serious complication with a variety in available treatment options. Endoscopic stenting is preferred because of its minimally invasive nature in morbidly obese patients. Various modifications have been applied to stents since its use in palliation of malignant strictures. Few studies have exclusively evaluated the efficacy of bariatric stents in management BL.

Methods

A retrospective cohort study of patients with BL managed by bariatric stents in the period between July 2014 and January 2019. The primary outcome was the clinical success in healing of leakage and secondary outcomes included adverse events (AEs), hospital stay and procedure-related mortality.

Results

Forty-five patients were included in this study. Clinical success occurred in 33 patients (73.3%). There was no stent-related mortality. The most frequent stent-related complications were reflux (62.2%), intolerance (55.6%), and migration (17.8%). Severe AEs occurred in 9 patients (20%). The overall complications rate was higher in diabetic patients (P = 0.048). Intolerance was significantly associated with shorter interval to management (P = 0.02). Stent migration was higher in male patients (P = 0.019) and higher BMI (P = 0.024).

Conclusion

Endoscopic stenting is a double-edged weapon that must be handled cautiously. It is a highly effective therapy, and early intervention is the main determinant of its efficacy. But it is not a treatment without complications (80%). The variant and high prevalence of complications mandates a strict follow-up throughout the stenting duration.
Literatur
1.
Zurück zum Zitat de Moura DTH, de Moura EGH, Neto MG, et al. Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis. 2019;15(8):1241–51.PubMedCrossRef de Moura DTH, de Moura EGH, Neto MG, et al. Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study. Surg Obes Relat Dis. 2019;15(8):1241–51.PubMedCrossRef
2.
Zurück zum Zitat Baptista A, De Moura DTH, Jirapinyo P, et al. Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas. Gastrointest Endosc. 2019;89(4):671–9.PubMedCrossRef Baptista A, De Moura DTH, Jirapinyo P, et al. Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas. Gastrointest Endosc. 2019;89(4):671–9.PubMedCrossRef
3.
Zurück zum Zitat Aryaie AH, Singer JL, Fayezizadeh M, et al. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc. 2017;31(2):612–7.PubMedCrossRef Aryaie AH, Singer JL, Fayezizadeh M, et al. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc. 2017;31(2):612–7.PubMedCrossRef
4.
Zurück zum Zitat Quezada N, Maiz C, Daroch D, et al. Effect of early use of covered self-expandable endoscopic stent on the treatment of postoperative stapler line leaks. Obes Surg. 2015;25(10):1816–21.PubMedCrossRef Quezada N, Maiz C, Daroch D, et al. Effect of early use of covered self-expandable endoscopic stent on the treatment of postoperative stapler line leaks. Obes Surg. 2015;25(10):1816–21.PubMedCrossRef
5.
Zurück zum Zitat 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. 2019;33(8):2691–5.PubMedCrossRef 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. 2019;33(8):2691–5.PubMedCrossRef
6.
Zurück zum Zitat Hunerbein M, Stroszczynski C, Moesta KT, et al. Treatment of thoracic anastomotic leaks after eophagectomy with self-expanding plastic stents. Ann Surg. 2004;240:801–7.PubMedPubMedCentralCrossRef Hunerbein M, Stroszczynski C, Moesta KT, et al. Treatment of thoracic anastomotic leaks after eophagectomy with self-expanding plastic stents. Ann Surg. 2004;240:801–7.PubMedPubMedCentralCrossRef
7.
Zurück zum Zitat Nicholson AA, Royston CMS, Wedgewood K, et al. Palliation of malignant oesophageal perforation and proximal oesophageal malignant dysphagia with covered metal stents. Clin Radiol. 1995;50:11–4.PubMedCrossRef Nicholson AA, Royston CMS, Wedgewood K, et al. Palliation of malignant oesophageal perforation and proximal oesophageal malignant dysphagia with covered metal stents. Clin Radiol. 1995;50:11–4.PubMedCrossRef
8.
Zurück zum Zitat Mumtaz H, Barone GW, Ketel BL, et al. Successful management of a non-malignant esophageal perforation with a coated stent. Ann Thorac Surg. 2002;74:1233–5.PubMedCrossRef Mumtaz H, Barone GW, Ketel BL, et al. Successful management of a non-malignant esophageal perforation with a coated stent. Ann Thorac Surg. 2002;74:1233–5.PubMedCrossRef
9.
Zurück zum Zitat Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2:570–2.PubMedCrossRef Salinas A, Baptista A, Santiago E, et al. Self-expandable metal stents to treat gastric leaks. Surg Obes Relat Dis. 2006;2:570–2.PubMedCrossRef
10.
Zurück zum Zitat Liu SY, Wong SK, Ng EK. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy. Obes Res Clin Pract. 2015;9(3):214–9.PubMedCrossRef Liu SY, Wong SK, Ng EK. Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy. Obes Res Clin Pract. 2015;9(3):214–9.PubMedCrossRef
11.
Zurück zum Zitat Wilcox VT, Huang AY, Tariq N, et al. Endoscopic suture fixation of self-expanding metallic stents with and without submucosal injection. Surg Endosc. 2015;29(1):24–9.PubMedCrossRef Wilcox VT, Huang AY, Tariq N, et al. Endoscopic suture fixation of self-expanding metallic stents with and without submucosal injection. Surg Endosc. 2015;29(1):24–9.PubMedCrossRef
12.
Zurück zum Zitat Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis. 2018;14(3):393–403.PubMedCrossRef Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis. 2018;14(3):393–403.PubMedCrossRef
13.
Zurück zum Zitat Okazaki O, Bernardo WM, Brunaldi VO, et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2018;28(6):1788–96.PubMedCrossRef Okazaki O, Bernardo WM, Brunaldi VO, et al. Efficacy and safety of stents in the treatment of fistula after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2018;28(6):1788–96.PubMedCrossRef
14.
Zurück zum Zitat Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, 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(1):8–19.PubMedCrossRef Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, 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(1):8–19.PubMedCrossRef
15.
Zurück zum Zitat Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446–54.PubMedCrossRef Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446–54.PubMedCrossRef
16.
Zurück zum Zitat Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.PubMedCrossRef Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.PubMedCrossRef
17.
Zurück zum Zitat Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.CrossRefPubMed Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.CrossRefPubMed
19.
Zurück zum Zitat Shehab H, Abdallah E, Gawdat K, et al. Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg. 2018;28(1):15–24.PubMedCrossRef Shehab H, Abdallah E, Gawdat K, et al. Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg. 2018;28(1):15–24.PubMedCrossRef
20.
Zurück zum Zitat Martin Del Campo SE, Mikami DJ, Needleman BJ, et al. Endoscopic stent placement for treatment of sleeve gastrectomy leak: a single institution experience with fully covered stents. Surg Obes Relat Dis. 2018;14(4):453–61.PubMedCrossRef Martin Del Campo SE, Mikami DJ, Needleman BJ, et al. Endoscopic stent placement for treatment of sleeve gastrectomy leak: a single institution experience with fully covered stents. Surg Obes Relat Dis. 2018;14(4):453–61.PubMedCrossRef
21.
Zurück zum Zitat Chang J, Sharma G, Boules M, et al. Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques. Surg Obes Relat Dis. 2016;12(7):1373–81.PubMedCrossRef Chang J, Sharma G, Boules M, et al. Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques. Surg Obes Relat Dis. 2016;12(7):1373–81.PubMedCrossRef
22.
Zurück zum Zitat Fishman S, Shnell M, Gluck N, et al. Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy. Gastrointest Endosc. 2015;81(5):1291–4.PubMedCrossRef Fishman S, Shnell M, Gluck N, et al. Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy. Gastrointest Endosc. 2015;81(5):1291–4.PubMedCrossRef
23.
Zurück zum Zitat Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.PubMedCrossRef Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27(8):2751–9.PubMedCrossRef
24.
Zurück zum Zitat Klimczak T, Klimczak J, Szewczyk T, et al. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc. 2018;32(4):2038–45.PubMedCrossRef Klimczak T, Klimczak J, Szewczyk T, et al. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc. 2018;32(4):2038–45.PubMedCrossRef
25.
Zurück zum Zitat Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis. 2014;10(4):613–7.PubMedCrossRef Puig CA, Waked TM, Baron Sr TH, et al. The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. Surg Obes Relat Dis. 2014;10(4):613–7.PubMedCrossRef
26.
Zurück zum Zitat Iqbal A, Miedema B, Ramaswamy A, et al. Long-term outcome after endoscopic stent therapy for complications after bariatric surgery. Surg Endosc. 2011;25(2):515–20.PubMedCrossRef Iqbal A, Miedema B, Ramaswamy A, et al. Long-term outcome after endoscopic stent therapy for complications after bariatric surgery. Surg Endosc. 2011;25(2):515–20.PubMedCrossRef
27.
Zurück zum Zitat Murino A, Arvanitakis M, Le Moine O, et al. Effectiveness of endoscopic management using self-expandable metal stents in a large cohort of patients with post-bariatric leaks. Obes Surg. 2015;25(9):1569–76.PubMedCrossRef Murino A, Arvanitakis M, Le Moine O, et al. Effectiveness of endoscopic management using self-expandable metal stents in a large cohort of patients with post-bariatric leaks. Obes Surg. 2015;25(9):1569–76.PubMedCrossRef
28.
Zurück zum Zitat Moon RC, Shah N, Teixeira AF, et al. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(1):54–9.PubMedCrossRef Moon RC, Shah N, Teixeira AF, et al. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(1):54–9.PubMedCrossRef
29.
Zurück zum Zitat Alazmi W, Al-Sabah S, Ali DA, et al. Treating sleeve gastrectomy leak with endoscopic stenting: the Kuwaiti experience and review of recent literature. Surg Endosc. 2014;28(12):3425–8.PubMedCrossRef Alazmi W, Al-Sabah S, Ali DA, et al. Treating sleeve gastrectomy leak with endoscopic stenting: the Kuwaiti experience and review of recent literature. Surg Endosc. 2014;28(12):3425–8.PubMedCrossRef
30.
Zurück zum Zitat Nimeri A, Ibrahim M, Maasher A, et al. Management algorithm for leaks following laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(1):21–5.PubMedCrossRef Nimeri A, Ibrahim M, Maasher A, et al. Management algorithm for leaks following laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(1):21–5.PubMedCrossRef
Metadaten
Titel
Outcome and Adverse Events of Endoscopic Bariatric Stents for Management of Leakage after Bariatric Surgery
verfasst von
Hosam Hamed
Mohammed Said
Hosam Elghadban
Ahmed Elgeidie
Publikationsdatum
04.01.2020
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 3/2020
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04373-7

Neu im Fachgebiet Chirurgie

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Mit Lidocain kommt der Darm nicht schneller in Schwung

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.