Effectiveness of Endoscopic Management Using Self-Expandable Metal Stents in a Large Cohort of Patients with Post-bariatric Leaks

Murino, Alberto; Arvanitakis, Marianna; Moine, Olivier Le; Bléro, Daniel; Devière, Jacques; Eisendrath, Pierre

doi:10.1007/s11695-015-1596-8

Cited by 52 publications

(43 citation statements)

References 24 publications

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“…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]. However, these stents are often difficult to remove [7].…”

Section: Discussionsupporting

confidence: 87%

“…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%

“…Endoscopic placement of a self-expandable stent is an increasingly used treatment option for staple line leakage after bariatric surgery [6, 8, 10–12]. This is the first large series describing the effectiveness and adverse event rate of the Niti-S Beta stent, a fully covered double-bump metal stent.…”

Section: Discussionmentioning

confidence: 99%

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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: 87%

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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“…In addition, the time interval between leak development and endoscopic stenting is a proven factor that impacts outcomes. The fibrotic transformation of leaks into chronic fistulas over time significantly decreases the probability of leak closure after stent placement[51,105,107]. Heterogeneity regarding all of these clinical factors may explain, at least in part, the large differences in rates of success across the studies.…”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

“…Other than migration, most complications are conservatively managed and not severe; however, severe bleeding and perforations have been observed. They are serious complications that have resulted in death in a few cases and in many occasions are associated with stent migration[107,111]. One explanation for the high migration rate is that SEES have been designed to treat benign and malignant esophageal strictures.…”

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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Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning

Hodgens

Bueno

2019

Multidisciplinary Approaches to Common Surgical Problems

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Effectiveness of Endoscopic Management Using Self-Expandable Metal Stents in a Large Cohort of Patients with Post-bariatric Leaks

Abstract: Endoscopic management using SEMS for anastomotic leaks after bariatric surgery is effective and may avoid risky surgical reintervention in 81 % of patients. Early stenting was a major significant factor associated with increased success.

Cited by 52 publications

References 24 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

Interventional Endoscopy: Endoluminal Therapy – Stenting, Clipping, and Suctioning

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