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Endoscopy management of sleeve gastrectomy stenosis: what we learned from 202 consecutive patients. Surg Obes Relat Dis 2023; 19:231-237. [PMID: 36323604 DOI: 10.1016/j.soard.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Gastric sleeve stenosis (GSS) is described in 1%-4% of patients. OBJECTIVE To evaluate the role of endoscopy in the management of stenosis after laparoscopic sleeve gastrectomy using a standardized approach according to the characteristic of stenosis. SETTING Retrospective, observational, single-center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS We enrolled 202 patients. All patients underwent endoscopy in a fluoroscopy setting, and a systematic classification of the type, site, and length of the GSS was performed. According to the characteristics of the stenosis, patients underwent pneumatic dilatation or placement of a self-expandable metal stent or a lumen-apposed metal stent. Failure of endoscopic treatment was considered an indication for redo surgery, whereas patients with partial or complete response were followed up for 2 years. In the event of a recurrence, a different endoscopic approach was used. RESULTS We found inflammatory strictures in 4.5% of patients, pure narrowing in 11%, and functional stenosis in 84.5%. Stenosis was in the upper tract of the stomach in 53 patients, whereas medium and distal stenosis was detected in 138 and 11 patients, respectively, and short stenosis in 194 patients. A total of 126 patients underwent pneumatic dilatation, 8 self-expandable metal stent placement, 64 lumen-apposed metal stent positioning, and 36 combined therapy. The overall rate of endoscopy success was 69%. CONCLUSION GSS should be considered to be a chronic disease, and the endoscopic approach seems to be the most successful treatment, with a prolonged positive outcome of 69%. Characteristics of the stenosis should guide the most suitable endoscopic approach.
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Manos T, Nedelcu M, Nedelcu A, Gagner M, Weiss AK, Bastid C, Carandina S, Noel P. Leak After Sleeve Gastrectomy: Updated Algorithm of Treatment. Obes Surg 2021; 31:4861-4867. [PMID: 34455540 DOI: 10.1007/s11695-021-05656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is currently the most common procedure performed worldwide, and still the leak is considered the main limitation. After an initial enthusiasm for stents, the endoscopic treatment evolved including in the current management the septotomy with balloon dilatation and pigtails insertions. The aim of this study was to evaluate the updated algorithm of endoscopic treatment of leak following LSG including septotomy and balloon dilatation. METHODS All consecutive patients treated by endoscopy between January 2018 and March 2020 for leak following LSG were included in the current study. After recording the demographic and the leak history, we have analyzed the number of endoscopic sessions, the duration of treatment, and the healing rate of endoscopic treatment for 3 groups: A, small orifice (< 10 mm); B, large orifice (> 10 mm) and acute leak; and group C with large orifice and late leak. RESULTS A total of 53 patients received endoscopic treatment for leak following LSG. The leaks achieved complete healing after average duration of 3.2 months (range 1-7 months), 2.3 months for group A, 4.2 months for group B, and 3.7 months for group C. The average number of endoscopic procedures was 2.8 (range 2-6) and was required for general population: for group A, 2.3 sessions; in group B, 3.4 sessions; and in group C, 2.7 sessions. Two out of 53 patients (3.8%) required additional treatment outside of the current algorithm, one in group A and another in group B. One patient was transferred for pulmonary abscess, and for another patient, the leak was considered chronic after a total of 14 months, and a laparoscopic fistula-jejunostomy was performed with favorable outcomes. CONCLUSIONS Although there is still no consensus for endoscopic management of leaks after LSG, the benefits of pigtails and the septotomy are undeniable, and it should be included in the armamentarium of any bariatric endoscopic service.
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Affiliation(s)
- Thierry Manos
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France. .,ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Place du 4 Septembre, 83100, Toulon, France.
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Place du 4 Septembre, 83100, Toulon, France
| | | | - Abdul Kader Weiss
- Emirates Specialty Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Christophe Bastid
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
| | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Place du 4 Septembre, 83100, Toulon, France
| | - Patrick Noel
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France.,Emirates Specialty Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.,Mediclinic Airport Road, Abu Dhabi, United Arab Emirates
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Archid R, Bazerbachi F, Abu Dayyeh BK, Hönes F, Ahmad SJS, Thiel K, Nadiradze G, Königsrainer A, Wichmann D. Endoscopic Negative Pressure Therapy (ENPT) Is Superior to Stent Therapy for Staple Line Leak After Sleeve Gastrectomy: a Single-Center Cohort Study. Obes Surg 2021; 31:2511-2519. [PMID: 33650088 PMCID: PMC8113301 DOI: 10.1007/s11695-021-05287-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Staple line leak (SLL) is a serious complication after sleeve gastrectomy (SG). Common endoscopic treatment options include self-expandable metallic stent (SEMS), endoscopic internal drainage (EID), and endoscopic closure. The endoscopic negative pressure therapy (ENPT) is a promising treatment option combining temporary sealing of the defect with drainage of the inflammatory bed. In this study, we compare the outcome of ENPT and SEMS for the treatment of SLL following SG. MATERIALS AND METHODS A retrospective cohort of 27 patients (21 females) treated at a single center for SLL after SG was included. ENPT was primary therapy for 14 patients and compared with 13 patients treated primarily using SEMS. RESULTS ENPT was associated with a significant reduction of hospital stay (19 ± 15.1 vs. 56.69 ± 47.21 days, p = 0.027), reduced duration of endoscopic treatment (9.8 ± 8.6 vs. 44.92 ± 60.98 days, p = 0.009), and shorter transabdominal drain dwell time (15 (5-96) vs. 45 (12-162) days, p = 0.014) when compared to SEMS. Whereas endoscopic management was successful in 12/14 (85.7%) of patients from the ENPT group, SEMS was successful in only 5/13 (38.5%) of patients (p = 0.015). Furthermore, ENPT was associated with a significant reduction of endoscopic adverse events compared with SEMS (14.3% vs. 76.92% p = 0.001). CONCLUSION Compared with SEMS, ENPT is effective and safe in treating SLL after SG providing higher success rates, shorter treatment duration, and lower adverse events rates.
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Affiliation(s)
- Rami Archid
- Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany.
| | - Fateh Bazerbachi
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Felix Hönes
- Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany
| | | | - Karolin Thiel
- Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany
| | - Giorgi Nadiradze
- Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany
| | - Alfred Königsrainer
- Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany
| | - Dörte Wichmann
- Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany
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Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17:1432-1439. [PMID: 33931322 DOI: 10.1016/j.soard.2021.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. OBJECTIVES To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. SETTING Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. RESULTS A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). CONCLUSION Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
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Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luca Paolino
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federica Papini
- Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d'Orsay, Orsay, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Kostas Arapis
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Bruto Randone
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Denis Chosidow
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Jean-Luc Bouillot
- Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
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