Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis

Abstract

Background Endoscopic techniques have become the first-line therapy in bariatric surgery-related complications such as leaks and fistulas. We performed a systematic review and meta-analysis on the effectiveness of self-expandable stents, clipping, and tissue sealants in closing of post-bariatric surgery leak/fistula. Methods A systematic literature search of the Medline/Scopus databases was performed to identify full-text articles published up to February 2019 on the use of self-expandable stents, clipping, or tissue sealants as primary endoscopic strategies used for leak/fistula closure. Meta-analysis of studies reporting stents was performed with the PRISMA guidelines. Results Data concerning the efficacy of self-expanding stents in the treatment of leaks/fistulas after bariatric surgery were extracted from 40 studies (493 patients). The overall proportion of successful leak/fistula closure was 92% (95% CI, 90-95%). The overall proportion of stent migration was 23% (95% CI, 19-28%). Seventeen papers (98 patients) reported the use of clipping: the over-the-scope clips (OTSC) system was used in 85 patients with a successful closure rate of 67.1% and a few complications (migration, stenosis, tear). The successful fistula/leak closure using other than OTSC types was achieved in 69.2% of patients. In 10 case series (63 patients), fibrin glue alone was used with a 92.8-100% success rate of fistula closure that usually required repeated sessions at scheduled intervals. The complications of fibrin glue applications were reported in only one study and included pain and fever in 12.5% of patients. Conclusions Endoscopic techniques are effective for management of post-bariatric leaks and fistulas in properly selected patients.

Non operative management of proximal posterior gastric injury in a trauma patient: A case report

“…Nonoperative management with gastric stent has been used and proven effective in gastric leaks resulting from bariatric surgeries and surgical interventions of gastric cancer. In fact, it is associated with a closure rate of 92%–96% [ 4 , 7 , 8 ]. This approach was sought in our patient and showed promising results.…”

“…Compared to reoperation, a gastric stent is a less invasive procedure, associated with decreased morbidity, mortality, and hospital stay. Additionally, stenting is advantageous because it allows patients to resume oral intake earlier [ 7 , 8 ]. However, our patient had multiple complications, including distal ulceration, migration, and para-stent leak.…”

“…Choi et al reported complications such as bleeding, stent fracture, stent impaction, and aorto-esophageal fistula. The optimal timing of stent removal is important as late removal increases the complication rate [ 7 , 8 ]. If the above less invasive management is followed in the future, it will provide a more convenient treatment option with less pain, less operative stay, and faster recovery.…”

A Rare Complication of Noncompliance Status Post-Transhiatal Esophagectomy and Esophago-Gastroanastomosis

“…In the absence of universal guidelines, there are conflicting reports on the proper care of GPF. A majority of reports agree that the laparoscopic approach and surgical interventions are definitive treatments as data indicate higher mortality with conservative management [ 7 – 9 ]. Meta-analysis of several case reports and retrospective studies has evaluated the outcomes of various surgical and endoscopic interventions.…”

“…Meta-analysis of several case reports and retrospective studies has evaluated the outcomes of various surgical and endoscopic interventions. Stent placement, endoscopic clipping techniques, or surgical sealants have all shown high success rates of repair with decreased morbidity and mortality when compared to nonsurgical therapies [ 8 , 9 ]. Contemporary studies have shown improving trends with fistula repairs with evidence implying that complex endoscopic surgical treatments or combined treatment with simultaneous or sequential endoscopic methods can optimize management [ 8 ].…”