Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study

Christophorou, Dimitri; Valats, Jean-Christophe; Funakoshi, Natalie; Duflos, Claire; Picot, Marie-Chistine; Vedrenne, B.; Prat, Frédéric; Bulois, Phillipe; Branche, Julien; Decoster, Sébastien; Coron, Emmanuel; Charachon, Antoine; Chambrun, Guillaume Pineton de; Nocca, David; Bauret, P.; Blanc, Pierre

doi:10.1055/s-0034-1392262

Cited by 56 publications

(36 citation statements)

References 17 publications

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“…Most gastric leaks after sleeve gastrectomy require stenting to achieve healing, although alternative treatments have been described. No consensus has been reached concerning the type of stent to be used for gastric leak; many types are available, such as a CS, DPS or over‐the‐scope clip. Few series have compared different types of stent in the endoscopic treatment of gastric leak after sleeve gastrectomy, and no cost analyses of the various types of endoscopic management have been published.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…There are fewer studies on those sealants than on fibrin glue, usually combining multiple techniques. Thus, we were unable to extract the specific effectiveness of tissue sealant instead of the effectiveness of other methods or combined endoscopic therapy from these studies [82]. Kotzampassi et al demonstrated high efficacy of 96.8% of cyanoacrylate in a heterogeneous series of 8 patients with fistulas after various types of surgery [95].…”

Section: Discussionmentioning

confidence: 97%

“…In addition, we presented the data regarding OTSC therapy from the study describing the use of endoscopic closing techniques alone versus endoscopic drainage (with or without other endoscopic techniques) [72]. We excluded from our analysis studies or study results reporting the concomitant use of stent or stent placement before clipping (Supplementary material, Figure S9) [40,66,70,72,75,77,78,[81][82][83][84][85][86][87][88][89][90][91]. Different definitions of therapy success were applied in the reviewed studies.…”

Section: Clipping Techniquesmentioning

confidence: 99%

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

et al. 2020

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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.

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“…As a result, there is an important heterogeneity in the management of these patients through the literature and the individual evaluation of each endoscopic modality is very difficult. Accordingly, one recent study has evaluated the overall efficacy of interventional endoscopy in this setting involving different techniques[137]. Among 110 included patients with post-LSG leaks, 74% healed with endoscopic treatment.…”

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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Endoscopic treatment of fistula after sleeve gastrectomy: results of a multicenter retrospective study

Abstract: Endoscopic treatment facilitated healing of post-LSG fistula in 74 % of patients. Early endoscopic treatment increased the likelihood of success, and was most effective during the first 6 months of management. After this point, surgical treatment should be considered.

Cited by 56 publications

References 17 publications

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

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

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

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

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