Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study

Moura, Diogo Turiani Hourneaux de; Moura, Eduardo Guimarães Hourneaux de; Neto, Manoel Galvão; Jirapinyo, Pichamol; Teixeira, Newton; Orso, Ivan Roberto Bonotto; Quadros, Luiz Gustavo de; Amorim, Artagnan Menezes Barbosa de; Medeiros, Filipe; Neto, Durval Rosa; Neto, João de Siqueira; Albano, Alvaro; Sousa, Luiz Henrique de; Almeida, Delano; Marchetti, Igor; Ivano, Flávio Heuta; Lima, João Henrique Felício de; Falcão, Marcelo; Thompson, Christopher C.

doi:10.1016/j.soard.2019.05.022

Cited by 28 publications

(34 citation statements)

References 30 publications

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“…Interestingly, in our experience and according to recent studies, the use of conventional esophageal SEMSs and specific customized SEMSs for sleeve gastrectomy has been associated with a high rate of adverse events such as gastroesophageal reflux symptoms, pain, nausea and vomiting, and stent migration. [15][16][17] In addition, a recent meta-analysis comparing stent versus EVT in upper GI defects showed higher rates of successful closure, a reduction in treatment duration, and lower mortality ratesdall favoring the EVT group. 18 It is critical to understand that patients with transmural defects, especially those with leaks, remain challenging, and an individualized approach is required.…”

Section: Discussionmentioning

confidence: 99%

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

et al. 2021

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Video Video 1 Cost-effective modified endoscopic vacuum therapy for GI transmural defects. Step-by-step process of manufacturing and potential advantages. Cut half gauze to the ideal size to cover only the fenestrated portion of the nasogastric tube (NGT). Wrap the gauze around the fenestrated portion of the NGT. The assistance of another person is important in this process. Cut the antimicrobial incise drape to match the size of the fenestrated portion of the NGT. Note that the incise drape is a very strong adhesive; therefore, 3 people are usually required to assemble it properly. Next, the suture is used to fix the gauze and drape to the NGT. Perform fixation of the modified sponge in 3 places. The first knot is in the proximal portion, just below the last fenestra of the NGT, as a marker of where the vacuum system starts. The second knot is at the distal end, to avoid migration of the modified sponge. The third knot is in the middle of the modified sponge, which is essential to serve as a guide during endoscopic placement. For example, in cases of defects without collection in which the sponge will be placed in an intraluminal position, it is ideal to place the vacuum system in the middle of the defect; in cases of intracavitary placement, it will work as a guide to how much of the modified sponge will be inside the collection. Finally, use a needle to make innumerable punctures in the modified sponge system to obtain adequate aspiration. An 18G needle is recommended because, in addition to having an adequate diameter, it is very sharp, which facilitates perforation of the modified sponge system. After creation of the modified endoscopic vacuum therapy, the functionality test is performed. Turn on the wall suction system, connect the distal end of the NGT to the tube of the canister connected on the wall, and place the NGT inside a bowl with a liquid solution. The aspiration of a large amount of liquid indicates proper functioning of the modified endoscopic vacuum therapy system. The device is then ready to be positioned endoscopically in the patient. After proper positioning, connect the NGT to the suction tube to avoid migration of the device upon removal of the scope. In addition to the cost-effective device as described, in our practice we also use wall suction to reduce costs associated with the use of the vacuum machine. Use the antimicrobial incise drape to seal the connection between the NGT and the suction tube to avoid leakage within the connection. Last, owing to instability of the negative wall pressure, a 20F intravenous catheter is connected to the tube to maintain a negative pressure between –75 and –150 mmHg, as confirmed by laboratory studies performed by our group.

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Section: Discussionmentioning

confidence: 99%

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

et al. 2021

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“…Such techniques can be considered in the treatment of acute VSG leaks given the paucity of other reliable treatment options currently available. 5…”

Section: Discussionmentioning

confidence: 99%

Novel suture placement to affix overlapping metal stents in the treatment of an acute leak after sleeve gastrectomy

Patel

Kwon

et al. 2020

VideoGIE

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Vertical sleeve gastrectomy (VSG) is an effective option for bariatric surgery, with weight loss comparable to that with Roux-en-Y gastric bypass. 1 Staple line leaks are rare but morbid adverse events after VSG. Early leaks are often treated with placement of fully covered self-expandable metal stents (FCSEMSs), although migration rates of 22% to 28% have been reported. 2,3 We present a novel method for endoscopic fixation of overlapping stents to treat a leak after VSG and to minimize migration risk.

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“…28 Diversion therapy facilitates early commencement of diet and when longer length stents are used, it can addressees downstream gastric stenosis. 29 Both partially covered SEMS (PCSEMS) and FCSEMS have been used for this purpose; however, a dichotomy exists. If a FCSEMS is used, it is essential to secure it in order to decrease the risk of migration.…”

Section: Functional Stenosis Precipitating and Propagating Leaks: Best Practice Advicementioning

confidence: 99%

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

Kumbhari

Cummings

Kalloo³

et al. 2021

Clinical Gastroenterology and Hepatology

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Endoscopic techniques are paramount in the identification and management of complications after surgery, though collaboration with other specialties is obligatory. Unfortunately, the evaluation and treatment algorithms are not standardized and there is a paucity of high-quality prospective studies to provide clarity regarding the best approach. The purpose of this clinical practice update is to apprise the clinician with respect to the endoscopic evaluation and management of patients with early (<90 days) complications after undergoing bariatric/ metabolic surgery. METHODS:The recommendations outlined in this expert review are based on available published evidence, including observational studies and systematic reviews, and incorporates expert opinion where applicable.

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Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study

Cited by 28 publications

References 30 publications

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

Cost-effective modified endoscopic vacuum therapy for the treatment of gastrointestinal transmural defects: step-by-step process of manufacturing and its advantages

Novel suture placement to affix overlapping metal stents in the treatment of an acute leak after sleeve gastrectomy

AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review

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