Endoscopic vacuum therapy as a first-line treatment option for gastric leaks after bariatric surgery: evidence from 10 years of experience

Kollmann, L.; Reimer, Stanislaus; Lock, Johan Friso; Flemming, Ilona; Widder, Anna; May, Jana; Krietenstein, Laura; Gruber, Maximilian; Meining, Alexander; Hankir, Mohammed K.; Germer, Christoph‐Thomas; Seyfried, Florian

doi:10.1016/j.soard.2023.02.010

Cited by 6 publications

(2 citation statements)

References 30 publications

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“…Additionally, patients often require a percutaneous endoscopic jejunostomy tube for enteral nutrition while the sponge is in place. Several studies report that EVT is safe and effective [ 62 , 63 , 64 ]. Although its feasibility as an initial modality for the treatment of sleeve leak is limited, given that it typically requires multiple endoscopic procedures, there may be a role for EVT in refractory cases of sleeve leak [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy

Masood,

Low,

Deal

et al. 2024

JCM

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Obesity is associated with serious comorbidities and economic implications. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, are effective options for weight loss and the improvement of obesity-related comorbidities. With the growing obesity epidemic, there has been a concomitant rise in bariatric surgeries, particularly in sleeve gastrectomy, which has been the most widely performed bariatric surgery since 2013. Gastroesophageal reflux disease (GERD) is highly prevalent in obese individuals, can significantly impact quality of life and may lead to serious complications. Obesity and GERD both improve with weight loss. However, as the incidence of sleeve gastrectomy rises, recent data have revealed a risk of exacerbation of pre-existing GERD or the development of de novo GERD following sleeve gastrectomy. We performed a detailed review of GERD post-sleeve gastrectomy, including its overall incidence, pathophysiology and current treatment paradigms.

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Section: Discussionmentioning

confidence: 99%

Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy

Masood,

Low,

Deal

et al. 2024

JCM

View full text Add to dashboard Cite

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“…In addition, a percutaneous endoscopic jejunostomy tube or a nasojejunal feeding tube for distal enteral feeding is usually required while the sponge is in place. EVT has been documented to be safe and efficacious [66][67][68][69][70]. The leak closure rate for EVT was reported to be 91.6% according to a recent meta-analysis [40].…”

Section: Endoscopic Vacuum Therapymentioning

confidence: 99%

Endoscopic Management of Post-Sleeve Gastrectomy Complications

Masood,

Low,

Deal

et al. 2024

JCM

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Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications.

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Additional over-the-scope-clip closure can shorten endoscopic vacuum therapy for postoperative upper gastrointestinal leakage

Brand,

Reimer,

Kollmann

et al. 2024

Endosc Int Open

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Background and study aims Endoscopic vacuum therapy (EVT) has become the most effective therapeutic option for upper gastrointestinal leakage. Despite its efficiency, this treatment can necessitate a long hospitalization. The aim of this study was to evaluate whether additional use of an over-the-scope-clips (OTSC) closure after successful EVT can shorten leakage therapy. Patients and methods All patients treated with EVT for leakages in the upper gastrointestinal tract at our center from 2012 to 2022 were divided into two propensity matched cohorts (EVT+OTSC vs. EVT only). The EVT+OTSC patients received OSTC application at the end of successful EVT directly after removal of the last sponge. The primary endpoint was the time interval from leakage diagnosis until discharge. Secondary endpoints included EVT efficacy, complications, and nutritional status at discharge. Results A total of 84 matched patients were analyzed. EVT efficacy was 100% in both groups. The time interval from leakage until discharge was significantly shorter in the EVT+OTSC vs. EVT group (33 [19–48] vs. 46 days [29–77] P = 0.004). No patient in the EVT+OTSC group required additional procedures for leakage management, whereas five (12%) in the EVT group needed additional stent placement (P = 0.021). More patients could be discharged on sufficient oral nutrition in the EVT+OTSC group (98% vs. 60%; P < 0.001). Conclusions The addition of OTSCs after successful EVT is safe and has the potential to shorten leakage therapy, enabling earlier discharge along with better functional outcomes.

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Endoscopic vacuum therapy as a first-line treatment option for gastric leaks after bariatric surgery: evidence from 10 years of experience

Cited by 6 publications

References 30 publications

Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy

Current Management and Treatment Paradigms of Gastroesophageal Reflux Disease following Sleeve Gastrectomy

Endoscopic Management of Post-Sleeve Gastrectomy Complications

Additional over-the-scope-clip closure can shorten endoscopic vacuum therapy for postoperative upper gastrointestinal leakage

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