Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure

Lorenzo, Diane; Guilbaud, Théophile; Gonzalez, Jean Michel; Benezech, Alban; Dutour, Anne; Boullu, S.; Berdah, Stéphane; Bège, Thierry; Barthet, Marc

doi:10.1016/j.gie.2017.07.032

Cited by 64 publications

(52 citation statements)

References 35 publications

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“…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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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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“…Systematic endoscopic review is advisable after 4 to 6 wk to avoid stent obstruction and to induce fistula traumatism (Figure 7 ). Lorenzo et al[ 69 ] in 2018 published a study comparing the outcomes of internal drainage versus closure (SEMS, glue or OTSC) for the management of fistula after SG in 100 patients. The efficacy of EID was significantly higher than that in the closure group (86% vs 64%; P = 0.55) and the mean (± SD) number of endoscopic sessions needed were 3.7 ± 3.4 per patient.…”

Section: Endoscopic Internal Drainagementioning

confidence: 99%

Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

Cereatti

Grassia

Drago

et al. 2020

WJG

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Gastrointestinal leaks and fistulae are serious, potentially life threatening conditions that may occur with a wide variety of clinical presentations. Leaks are mostly related to post-operative anastomotic defects and are responsible for an important share of surgical morbidity and mortality. Chronic leaks and long standing post-operative collections may evolve in a fistula between two epithelialized structures. Endoscopy has earned a pivotal role in the management of gastrointestinal defects both as first line and as rescue treatment. Endotherapy is a minimally invasive, effective approach with lower morbidity and mortality compared to revisional surgery. Clips and luminal stents are the pioneer of gastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing system and vacuum therapy, has broadened the indications of endoscopy for the management of GI wall defect. Although several endoscopic options are currently used, a standardized evidence-based algorithm for management of GI defect is not available. Successful management of gastrointestinal leaks and fistulae requires a tailored and multidisciplinary approach based on clinical presentation, defect features (size, location and onset time), local expertise and the availability of devices. In this review, we analyze different endoscopic approaches, which we selected on the basis of the available literature and our own experience. Then, we evaluate the overall efficacy and procedural-specific strengths and weaknesses of each approach.

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“…The incidence of fistula development has been reported to occur in up to 14% of patients with anastomotic leaks [13]. A leak can evolve into a fistula with an epitheliazed tract if the leak does not heal in a timely manner [44,81]. The most common sites for fistula formation are the gastro-gastric and gastro-cutaneous fistulas.…”

Section: Fistulasmentioning

confidence: 99%

Endoscopic therapeutic interventions for management of postoperative bariatric surgery complications

Westerveld

Sharaiha

2020

Techniques and Innovations in Gastrointestinal Endoscopy

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Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure

Cited by 64 publications

References 35 publications

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

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

Endoscopic management of gastrointestinal leaks and fistulae: What option do we have?

Endoscopic therapeutic interventions for management of postoperative bariatric surgery complications

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