A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski, Mihajlo; Imam, Zaid; Cappell, Mitchell S.; Jamil, Laith H.; Kahaleh, Michel

doi:10.1097/mcg.0000000000001451

Cited by 24 publications

(25 citation statements)

References 431 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The patient was readmitted with septic shock due to gallbladder empyema and pneumonia; despite maximum intensive care treatment, the patient developed multiorgan failure and died. In line with published literature [43], our data confirmed GL as a potentially life-threatening complication of LSG (mortality = 8.7%).…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

et al. 2021

View full text Add to dashboard Cite

Purpose Gastric staple line leakage (GL) is a serious complication of laparoscopic sleeve gastrectomy (LSG), with a specific mortality ranging from 0.2 to 3.7%. The current treatment of choice is stent insertion. However, it is unclear whether the type of stent which is inserted affects treatment outcome. Therefore, we aimed not only to determine the effectiveness of stent treatment for GL but also to specifically clarify whether treatment outcome was dependent on the type of stent (small- (SS) or megastent (MS)) which was used. Patients and Methods A single-centre retrospective study of 23 consecutive patients was conducted to compare the outcomes of SS (n = 12) and MS (n = 11) for the treatment of GL following LSG. The primary outcome measure was the success rate of stenting, defined as complete healing of the GL without changing the treatment strategy. Treatment change or death were both coded as failure. Results The success rate of MS was 91% (10/11) compared to only 50% (6/12) for SS (p = 0.006). An average of 2.3 ± 0.5 and 6.8 ± 3.7 endoscopies were required to achieve healing in the MS and SS groups respectively (p < 0.001). The average time to resumption of oral nutrition was shorter in the MS group (1.4 ± 1.1 days vs. 23.1 ± 33.1 days, p = 0.003). Conclusions Stent therapy is only effective and safe for the treatment of GL after LSG if a MS is used. Treatment with a MS may not only increase treatment success rates but may also facilitate earlier resumption of oral nutrition and shorten the duration of hospitalization. Graphical Abstract

show abstract

Section: Discussionsupporting

confidence: 92%

“…abdominal pain in 15-97% of patients and removal in 11-15% [15,16,36,37,39]). Bleeding and perforation are also recognised complications of stenting, with incidences in the literature [25,27,32,43] ranging respectively from 0 to 11.8% and from 0 to 8.4%. These complications were not encountered in our patients.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Gastric leak may be caused by multiple factors, including technical, mechanical, and ischemic causes. Stapler misfiring, defects in sleeve stapling and suturing, devascularization of the gastric fundus at the angle of His, gastric stenosis, and kinking are all factors contributing to its genesis [4,6].…”

Section: Discussionmentioning

confidence: 99%

“…The first consists of a laparoscopic revision that includes re-suturing and drainage. The second includes the endoscopic delivery of different types of stents, closure devices, internal drainages, and suturing [3,4].…”

Section: Introductionmentioning

confidence: 99%

Esophageal Stent in Sleeve Gastrectomy Leak Treatment: Observations Based on a Challenging Surgical Case and Literature

Frattini¹,

Rizzi²,

Segato

et al. 2021

Surgeries

View full text Add to dashboard Cite

Gastric leak is a serious complication of sleeve gastrectomy with a well-documented morbidity and mortality. Depending on the series the leak rate ranges between 1 and 5%. The treatment of sleeve gastrectomy leak is still challenging. Different procedures have been described in management of gastric leak, both surgical and endoscopic. The treatment of gastric leaks depends on the extent of the staple-line leak, the site of the leak and its association with stenosis. As published data are limited, there are no still standardized guidelines on best treatment. One of the most commonly used option in the treatment of gastric leak is esophageal stent. Its success rate reaches 70–80% but it is burdened by some complications. Stent migration is the most common complication in the placement of esophageal stent.We present a challenging surgical in which case the use of an esophageal stent for the treatment of a sleeve gastrectomy leak gained the resolution of the leak but was complicated by bowel obstruction due to migration of the stent.

show abstract

“…Several approaches are described to treat patient with postoperative GL including observation, endoscopic suturing or sealing, reintervention, percutaneous drainage and endoscopic or radiological stenting [17,18,19,20,21,22,23,24,25]. In most cases, the type of leak and the clinical condition of the patient are the main factors that define the chosen treatment option.…”

Section: Introductionmentioning

confidence: 99%

Radiological stent placement of post sleeve gastrectomy leak: efficacy, imaging features and post-procedure complications

Scavone

Caltabiano

Inì³

et al. 2022

Heliyon

View full text Add to dashboard Cite

Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric procedure. The primary and insidious early post-SG complication is the gastric leak (GL). In literature, there are many studies describing the endoscopic stent placement as treatment of GL and few studies about stent placement performed by interventional radiology under fluoroscopic guide. Our aims were to describe the radiological stent placement technique, to compare endoscopic and radiological stent placement, to illustrate normal diagnostic features and summarise the incidence of complications after stent placement, removal, and their imaging features. This was a single centre retrospective study of 595 patients who underwent SG between 2011 and 2019. Inclusion criteria: patients who developed GL after SG and treated with gastro-oesophageal stent placement by endoscopy or interventional radiology; availability of medical history and imaging studies; follow-up time after stent removal (1 year). The rates of technical success, clinical success and complications after stent placement and removal were collected and compared between the two methods of stent positioning. A total of 17/595 (2.8%) patients developed a radiologically diagnosed GL after SG. The type II-III GLs (15/17) were treated with endoscopic or radiological stent placement. 9/15 (60%/Group A) patients underwent gastro-oesophageal stenting by interventional radiology and 6/15 (40%/Group B) were treated with endoscopic stent placement. The technical and clinical success rate was 100% for both groups. Stent migration occurred in 22% and 27% for Group A and B respectively. Post-extraction stenosis was the main late complication, occurring in 22% in Group A and 0% in Group B. Gastro-esophageal stent placement performed by interventional radiologists is a valid "mini-invasive" treatment for GL. This procedure is not inferior to endoscopic positioning regarding efficacy, periprocedural and postprocedural complication rate. It's necessary to be familiar with radiological findings after stent placement and removal. Computed tomography (CT) scan is the main radiological technique to identify stent placement complications. Upper gastrointestinal (UGI) series are the first radiological procedures used to detect late complications after stent removal.

show abstract

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Cited by 24 publications

References 431 publications

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used

Esophageal Stent in Sleeve Gastrectomy Leak Treatment: Observations Based on a Challenging Surgical Case and Literature

Radiological stent placement of post sleeve gastrectomy leak: efficacy, imaging features and post-procedure complications

Contact Info

Product

Resources

About