An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video)

Shehab, Hany; Hakky, Sherif; Gawdat, Khaled

doi:10.1007/s11695-015-1857-6

Cited by 56 publications

(50 citation statements)

References 25 publications

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“…Despite the novel double-bump structure of the Beta stent, which has specifically been designed to prevent migration, migration occurred in 32% of patients (26% of stents) in this study. This seems comparable to the results of other fully covered stents, with a migration rate of 18–67% in previous studies [8, 11, 16, 17, 19, 20]. Partially covered stents are less prone to migration with a migration rate of 5–15% [7, 10, 14, 15, 18].…”

Section: Discussionsupporting

confidence: 88%

“…In previous studies, mortality was described as well, most often not stent-related [5, 7, 8, 24]. Stent-related deaths, due to perforation or bleeding, were described in two studies [10, 19]. In one study, a fatal bleeding was caused by the mechanical pressure of the stent, which caused the bleeding in this study too [19].…”

Section: Discussionmentioning

confidence: 62%

“…Stent-related deaths, due to perforation or bleeding, were described in two studies [10, 19]. In one study, a fatal bleeding was caused by the mechanical pressure of the stent, which caused the bleeding in this study too [19]. Therefore, this adverse event does not seem to be unique for the Beta stent.…”

Section: Discussionmentioning

confidence: 80%

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A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

et al. 2018

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BackgroundStaple line leakage after bariatric surgery can be treated by endoscopic placement of a self-expandable stent. The success rate of stent placement is generally high, but migration is a frequent adverse event that hampers successful treatment. The Niti-S Beta stent is a fully covered double-bump stent that was specifically designed to prevent migration. This study aimed to evaluate the effectiveness and adverse event rate of the Niti-S Beta stent.MethodsA retrospective study was performed in three high-volume bariatric centers. All consecutive patients between 2009 and 2016 who underwent placement of a Beta stent for staple line leakage were included. Primary outcome was resolution of the leakage; secondary outcome was the adverse event rate including migration.ResultsThirty-eight patients were included. Twenty-five (66%) had resolution of the leakage. Success rate was higher in patients who were treated with implantation of a Beta stent as initial treatment (100%) than in patients who were treated with a stent after revisional surgery had failed (55%, p = 0.013). Migration occurred in 12 patients (32%). There were two severe adverse events requiring surgical intervention, including a bleeding from an aorto-esophageal fistula.ConclusionsThe success rate and the migration rate of the Beta stent seem comparable to other stents in this retrospective study. Despite the novel double-bump structure of the stent, the migration rate does not seem to be decreased.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 62%

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A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

et al. 2018

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“…This is the endoscopic treatment for leaks after bariatric surgery where most evidence is available. Table 2 shows the largest studies in the literature reporting on stent treatment of leaks after bariatric surgery[98-111]. In one meta-analysis on 7 studies published in 2011, fistula closure was achieved in 88%.…”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

“…The rate of successful removal of the stent after leak closure was 92% and stent migration, noted in 17% of cases, was the most common complication[64]. However, the largest studies have been published after this meta-analysis and the rates of leak closure and complications range from 65% to 100% and 14% to 86%, respectively, with migration being the most frequent complication with rates of 5%-67%[98-111]. It is noteworthy that figures of success in most studies have included not only primary success following stenting but also success after combining stenting with other complementary endoscopic techniques.…”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Souto-Rodríguez¹,

Alvarez-Sánchez²

2017

WJGE

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Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

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Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy

Cossé

Rebibo

Brazier

et al. 2018

British Journal of Surgery

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An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video)

Abstract: Mega stents are effective in the management of post-bariatric surgery leaks. The combined use of Mega stents and OTSC clips is associated with a low incidence of migration and a low number of stents and procedures required per patient.

Cited by 56 publications

References 25 publications

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy

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