Endoscopic treatment of post vertical gastrectomy fistula: septotomy associated with air expansion of incisura angularis

Lima, João Henrique Felício de

doi:10.1590/s0102-6720201400s100020

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Septotomy or fenestration is a technique of cutting the pseudoseptum between perigastric cavity and gastric lumen using needle knife, cutting knife, or APC probe, to facilitate drainage. 55,200,289,[353][354][355][388][389][390][391][392][393][394][395] It addresses the pressure gradient that drives gastric contents from the lumen into perigastric collection, and by completely exposing the leak cavity, it equalizes the interluminal pressures 391 (Fig. 11).…”

Section: Transfistulary Stentingmentioning

confidence: 99%

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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Background: Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.Objective: To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.Design: A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.Results: Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. Conclusion:Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.

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Section: Transfistulary Stentingmentioning

confidence: 99%

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Gjeorgjievski¹,

Imam

Cappell

et al. 2020

Journal of Clinical Gastroenterology

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“…More recently, the same investigators described an updated technique that is very similar to our practice [13]. Case reports from Brazil and the United States have also reported success with this approach in individual cases [14,15]. The technique appears to be effective even in chronic fistulae, although multiple procedures are required.…”

Section: Discussionmentioning

confidence: 90%

Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections

et al. 2017

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Staple-line leaks occur in 1 % - 7 % of patients who undergo sleeve gastrectomy, and can be challenging to treat. The success of endoscopic approaches decreases as leaks develop into chronic sinus tracts. Endoscopic septotomy has been used to facilitate healing of refractory leaks by incision and enlargement of the tract to allow direct communication with the gastric lumen and internal drainage. We reviewed the technique and outcomes among patients who underwent endoscopic septotomy at two centers for the management of sleeve gastrectomy-associated gastric fistulas and perigastric collections refractory to occlusive endoscopic therapies. Nine patients underwent endoscopic septotomy at a mean of 8.6 weeks after leak diagnosis, following failure of percutaneous and conventional endoscopic modalities. Perigastric collections ranged from 3 cm to 10 cm in size. The mean procedure time for endoscopic septotomy was 87.2 minutes. Multiple endoscopic septotomy procedures (mean 2.3, range 1 - 4) were required to achieve radiological resolution. The mean follow-up period was 21.2 weeks, and all nine patients achieved symptom resolution without the need for surgery. Bleeding at the time of endoscopic septotomy occurred in three patients, and was managed with endoscopic clips and did not require transfusion. No other adverse events or delayed complications were recorded. Endoscopic septotomy appears to be a safe and effective technique for the management of sleeve gastrectomy-associated fistulae and collections, including those refractory to other endoscopic and percutaneous methods.

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“…Without resolving the distal stricture, intraluminal sleeve pressures remained high, which did not favor abscess drainage into the cavity and eventual resolution. Lima [26] described his technique in 2014, using endoscopic septotomy for the treatment of a female patient 30 days after the LSG with complete resolution of the leak at 30-day follow-up. Moreover, the author discussed use of septotomy in 10 previous patients with leak resolution no later than 60 days.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

et al. 2020

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Background and study aims Sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world. Leaks are the most feared complications after this procedure. Endoscopic septotomy has been described as a resolution technique that could be useful in the setting of late and chronic leaks. We present our experience in the management of gastric leaks with this advanced endoscopic technique. Patients and methods Retrospective review of patients who have been admitted to our hospital from January 2016 to December 2018. Results Five patients were found. All had their index surgery in outside hospitals. The average age was 51 years (range 40 – 69), and four patients were female. Mean time from LSG to leak presentation was 15 days (range 7 – 25). Mean time from leak presentation to septotomy procedure was 61 days (range 21 – 110). All patients were treated with sleeve dilatation before septotomy using endoscopic achalasia balloons. Mean procedure time was 79 minutes (range 55 – 125). Success was achieved in 80 % of patients, and no complications related to the procedure were identified. One patient underwent total gastrectomy for definitive management. Mean follow-up time was 14.25 months (range 6 – 26), and the average time for fistula closure was 60.25 days. Conclusion Endoscopic septotomy is safe and effective for management of chronic leaks after LSG. Associated non-selective dilatation may be a crucial step to allow distal patency and axis rectification for appropriate leak closure.

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Endoscopic treatment of post vertical gastrectomy fistula: septotomy associated with air expansion of incisura angularis

Cited by 9 publications

References 4 publications

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks

Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections

Endoscopic septotomy as a treatment for leaks after sleeve gastrectomy

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