Customized bariatric stents for sleeve gastrectomy leak: are they superior to conventional esophageal stents? A systematic review and proportion meta-analysis

Hamid, Hytham K. S.; Emile, Sameh Hany; Saber, Alan A.; Dincer, Mürşit; Gilissen, Lennard P L; Almadi, Majid A; Montuori, Mauro; Vix, Michel; Périssé, Luís Gustavo Santos; Quezada, Nicolás; Garofalo, Fabio; Pescarus, Radu

doi:10.1007/s00464-020-08147-6

Cited by 23 publications

(11 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, in our experience and according to recent studies, the use of conventional esophageal SEMSs and specific customized SEMSs for sleeve gastrectomy has been associated with a high rate of adverse events such as gastroesophageal reflux symptoms, pain, nausea and vomiting, and stent migration. [15][16][17] In addition, a recent meta-analysis comparing stent versus EVT in upper GI defects showed higher rates of successful closure, a reduction in treatment duration, and lower mortality ratesdall favoring the EVT group. 18 It is critical to understand that patients with transmural defects, especially those with leaks, remain challenging, and an individualized approach is required.…”

Section: Discussionmentioning

confidence: 99%

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

et al. 2021

View full text Add to dashboard Cite

Video Video 1 Cost-effective modified endoscopic vacuum therapy for GI transmural defects. Step-by-step process of manufacturing and potential advantages. Cut half gauze to the ideal size to cover only the fenestrated portion of the nasogastric tube (NGT). Wrap the gauze around the fenestrated portion of the NGT. The assistance of another person is important in this process. Cut the antimicrobial incise drape to match the size of the fenestrated portion of the NGT. Note that the incise drape is a very strong adhesive; therefore, 3 people are usually required to assemble it properly. Next, the suture is used to fix the gauze and drape to the NGT. Perform fixation of the modified sponge in 3 places. The first knot is in the proximal portion, just below the last fenestra of the NGT, as a marker of where the vacuum system starts. The second knot is at the distal end, to avoid migration of the modified sponge. The third knot is in the middle of the modified sponge, which is essential to serve as a guide during endoscopic placement. For example, in cases of defects without collection in which the sponge will be placed in an intraluminal position, it is ideal to place the vacuum system in the middle of the defect; in cases of intracavitary placement, it will work as a guide to how much of the modified sponge will be inside the collection. Finally, use a needle to make innumerable punctures in the modified sponge system to obtain adequate aspiration. An 18G needle is recommended because, in addition to having an adequate diameter, it is very sharp, which facilitates perforation of the modified sponge system. After creation of the modified endoscopic vacuum therapy, the functionality test is performed. Turn on the wall suction system, connect the distal end of the NGT to the tube of the canister connected on the wall, and place the NGT inside a bowl with a liquid solution. The aspiration of a large amount of liquid indicates proper functioning of the modified endoscopic vacuum therapy system. The device is then ready to be positioned endoscopically in the patient. After proper positioning, connect the NGT to the suction tube to avoid migration of the device upon removal of the scope. In addition to the cost-effective device as described, in our practice we also use wall suction to reduce costs associated with the use of the vacuum machine. Use the antimicrobial incise drape to seal the connection between the NGT and the suction tube to avoid leakage within the connection. Last, owing to instability of the negative wall pressure, a 20F intravenous catheter is connected to the tube to maintain a negative pressure between –75 and –150 mmHg, as confirmed by laboratory studies performed by our group.

show abstract

Section: Discussionmentioning

confidence: 99%

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Among available interventions, self-expandable metallic stent (SEMS) placement has been most commonly examined. Meta-analyses have shown that the leak closure rates of SEMS placement are 82%–93% [4, 5]. However, approximately 15%–32% of patients experience stent migration [4, 5], and the use of >1 stent, which is expensive, might be required during treatment.…”

Section: Introductionmentioning

confidence: 99%

Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Introduction: Several endoscopic methods can be employed to manage post-bariatric leaks. However, endoluminal vacuum therapy (EVT) and endoscopic internal drainage (EID) are relatively new methods, and studies regarding these methods are scarce. We performed a systematic review of the literature and a meta-analysis to evaluate the efficacy of EVT and EID. Methods: Databases were searched for eligible studies. The clinical success of leak closure was the primary outcome of interest. A proportional meta-analysis was performed for pooling the primary outcome using a fixed-effects model. A meta-analysis or descriptive analysis of other outcomes was performed based on the data availability. Results: Data from 3 EVT and 10 EID studies (n = 279) were used for evidence synthesis. The leak closure rates (95% confidence interval [CI]) of EVT and EID were 85.2% (75.1%–95.4%) and 91.6% (88.1%–95.2%), respectively. The corresponding mean treatment durations (95% CI) were 28 (2.4–53.6) and 78.4 (50.1–106.7) days, respectively. However, data about other outcomes were extremely limited; thus, a pooled analysis could not be performed. Conclusions: Both EVT and EID were effective when used as the first-line treatment for post-bariatric leaks. However, larger studies must be conducted to compare the efficacy of the 2 interventions.

show abstract

“…Furthermore, the investigations by Okazaki et al and Hamid et al [8,9] should be interpreted very cautiously because these meta-analyses include studies with both acute/ early leaks and chronic fistulae, limiting the generalizability of the data, since the literature consistently shows that acute/early leaks are very different from late/chronic fistulae. In fact, the authors' flow chart of treatment selection clearly differentiates treatments based on the timing of the leak.…”

mentioning

confidence: 99%

Endoscopic Stent Placement to Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy: the Bigger, the Better

et al. 2022

View full text Add to dashboard Cite

Customized bariatric stents for sleeve gastrectomy leak: are they superior to conventional esophageal stents? A systematic review and proportion meta-analysis

Cited by 23 publications

References 49 publications

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis

Endoscopic Stent Placement to Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy: the Bigger, the Better

Contact Info

Product

Resources

About