Three Cases of Fistulae Arising from Gastrointestinal Tract Treated with Endoscopic Injection of Histoacryl®

Lee, Y. C.; Na, H. G.; Suh, Jung Hoon; Park, In Sun; Chung, Kyoung Young; Kim, Nam Kyu

doi:10.1055/s-2001-11670

Cited by 47 publications

(10 citation statements)

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“…In comparison to coverage to lead to natural sealing of a defect, complete closure of a leak or fistula is more challenging. Endoscopic injection of Histoacryl [ 28 ] or suturing devices [ 29 ] have been introduced to close post-bariatric leaks or revisions. Recently, the use of fibrin sealants or an over-the-scope clip (OTSC ® ; Ovesco AG, Tübingen, Germany) has been considered the main strategy to close a leak or fistula after bariatric surgery.…”

Section: Leak and Fistulamentioning

confidence: 99%

Endoscopic Approach for Major Complications of Bariatric Surgery

Joo

2017

Clin Endosc

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As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.

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Section: Leak and Fistulamentioning

confidence: 99%

Endoscopic Approach for Major Complications of Bariatric Surgery

Joo

2017

Clin Endosc

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“…Five patients (56%) presented with a proximal staple-line leak (at the angle of His), 3 (33%) with an anastomotic leak and 1 (11%) with leaks at both sites. Median time between surgery and first endoscopy was 12 days (IQR [10][11][12][13][14][15][16][17][18][19] and the median number of therapeutic endoscopic sessions was 3 (IQR 2-6). All patients were treated with fully covered stents for a median period of 26 days (IQR 11-30).…”

Section: Postoperative Leak Groupmentioning

confidence: 99%

“…These goals may be achieved by deploying fully covered self-expanding metal stents (FC-SEMS) [8][9][10][11][12][13]. Other strategies including over the scope clips, fibrin glue, endoscopic suturing and intragastric drainage (IGD) with double pigtail stent have been all described with variable success rate [9,[14][15][16][17]. In cases of chronic leak with perigastric collection formation, the preferred and effective endoscopic approach is to enable adequate drainage of the perigastric collection into the stomach by dissecting the septum separating the two cavities (septotomy) [18] or by inserting double pigtail stent.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

et al. 2020

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Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-thescope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results: Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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“…These goals may be achieved by deploying fully covered self-expanding metal stents (FC-SEMS) [8][9][10][11][12][13]. Other strategies including over the scope clips (OTSC), fibrin glue, endoscopic suturing and intragastric drainage (IGD) with double pigtail stent (DPS) have been all described with variable success rate [9,[14][15][16][17]. In cases of chronic leak with perigastric collection formation, a typical complication of laparoscopic sleeve gastrectomy (LSG), the preferred (an effective) endoscopic approach is to enable adequate drainage of the perigastric collection into the stomach by dissecting the septum separating the two cavities (septotomy), and to reduce the intragastric pressure by realignment of the sleeve axis using pneumatic balloon dilatation [18].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of leaks and strictures after laparoscopic one anastomosis gastric bypass

Younis

Shnell

Gluck

et al. 2019

Preprint

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Background: Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications. Methods: This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention. Results: Nine patients presented with acute or early leaks: 5 (55.6%) had staple-line leaks, 3 (33.3%) had anastomotic leaks and 1 (11.1%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44.4%). Overall 5 patients (55.6%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22.2%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilatation. Conclusion: Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.

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Three Cases of Fistulae Arising from Gastrointestinal Tract Treated with Endoscopic Injection of Histoacryl®

Cited by 47 publications

References 0 publications

Endoscopic Approach for Major Complications of Bariatric Surgery

Endoscopic Approach for Major Complications of Bariatric Surgery

Endoscopic treatment of early leaks and strictures after laparoscopic one anastomosis gastric bypass

Endoscopic treatment of leaks and strictures after laparoscopic one anastomosis gastric bypass

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