Endoscopic Management of Post-Laparoscopic Sleeve Gastrectomy Leakage and Stenosis Using Fully Covered Stent

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed surgery to treat morbid obesity. Post-LSG leak and stenosis are serious complications that can be associated with significant morbidity and mortality. Objective: The objective was to report the efficacy and safety profile of using specifically designed fully covered self-expandable metallic stent for the treatment of post-LSG complications. Methods: This retrospective study included adult patients who underwent placement of a fully covered esophagogastric, self-expandable metallic stent for post-LSG leak or stenosis. The procedure was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between September 2017 and May 2019. Data regarding demographics, indication for stenting, size of the stent, procedural success and poststenting adverse events were collected. Results: A total of 14 patients met the inclusion criteria, with indication for endoscopic stenting being post-LSG leak in 11 patients and stenosis in 3 patients. The technical success rate of self-expandable metallic stent placement was 100%, and the clinical success was 85.7% (12 of 14 patients). Nausea (71.4%) and vomiting (85.7%) were the most frequent mild adverse events reported. Stent-induced esophageal stricture was the only major adverse event reported in two patients. Conclusion: Placement of specifically designed self-expandable metallic stent for the treatment of post-LSG leak and stenosis is an effective and safe approach. Further studies with larger cohorts are needed to assess the optimal duration needed to treat such complications.

Endoscopic Management of Post-Sleeve Gastrectomy Complications

“…Recently, bariatric-specific stents, i.e., Niti-S MEGA™ stent (Taewoong Medical Industries, Gimpo-si, Republic South of Korea), Niti-S BETA™ stent (Taewoong Medical Industries, Gimpo-si, Republic South of Korea), and Gastro-Seal™ stent (M.I. Tech, Pyeongtaeksi, Republic South of Korea), have emerged which generally have a larger stent diameter and a longer stent length to suit patients with sleeve gastrectomy [32,[34][35][36]. Despite a high leak closure rate with bariatric-specific stents, significant morbidity has been reported [37].…”