Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy

Fishman, Sigal; Shnell, Mati; Gluck, Nathan; Meirsdorf, Shmuel; Abu‐Abeid, Subhi; Santo, Erwin

doi:10.1016/j.gie.2014.11.012

Cited by 32 publications

(25 citation statements)

References 13 publications

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“…Despite the novel double-bump structure of the Beta stent, which has specifically been designed to prevent migration, migration occurred in 32% of patients (26% of stents) in this study. This seems comparable to the results of other fully covered stents, with a migration rate of 18–67% in previous studies [8, 11, 16, 17, 19, 20]. Partially covered stents are less prone to migration with a migration rate of 5–15% [7, 10, 14, 15, 18].…”

Section: Discussionsupporting

confidence: 88%

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

et al. 2018

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BackgroundStaple line leakage after bariatric surgery can be treated by endoscopic placement of a self-expandable stent. The success rate of stent placement is generally high, but migration is a frequent adverse event that hampers successful treatment. The Niti-S Beta stent is a fully covered double-bump stent that was specifically designed to prevent migration. This study aimed to evaluate the effectiveness and adverse event rate of the Niti-S Beta stent.MethodsA retrospective study was performed in three high-volume bariatric centers. All consecutive patients between 2009 and 2016 who underwent placement of a Beta stent for staple line leakage were included. Primary outcome was resolution of the leakage; secondary outcome was the adverse event rate including migration.ResultsThirty-eight patients were included. Twenty-five (66%) had resolution of the leakage. Success rate was higher in patients who were treated with implantation of a Beta stent as initial treatment (100%) than in patients who were treated with a stent after revisional surgery had failed (55%, p = 0.013). Migration occurred in 12 patients (32%). There were two severe adverse events requiring surgical intervention, including a bleeding from an aorto-esophageal fistula.ConclusionsThe success rate and the migration rate of the Beta stent seem comparable to other stents in this retrospective study. Despite the novel double-bump structure of the stent, the migration rate does not seem to be decreased.

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Section: Discussionsupporting

confidence: 88%

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

et al. 2018

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“…However, the funnel plot, sensitivity analysis and the Begg's test suggested an existing bias and asymmetry between the studies (Supplementary material: Figure S1). Therefore, several studies were excluded [48,52,62]. After excluding above studies, the remaining studies were homogenous (I 2 = 0.00%, p = 0.77) and the overall proportion of successful leak or fistula closure did not change significantly-92% (95% CI, (90-95%) (Supplementary material: Figure S2).…”

Section: Overall Proportion Of Successful Leak Closurementioning

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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“…They have a larger diameter to ensure optimal adherence to the sleeve wall and are longer, up to 24 cm, to allow the proximal end to be placed in the distal esophagus and the distal end in the duodenal bulb to decrease migration. Whether these stents reduce the rate of migration is not clear because few cases have been reported and migration has been observed in 18% to 67%[108-111]. However, one highlighted advantage is that these stents are always retrievable endoscopically because their larger sizes prevent them to migrate far distally in contrast with conventional stents[111].…”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

“…Two problems have been observed with these stents. The first one is the worse tolerability to the stent requiring stent removal in some cases, with common pain, heartburn and vomiting due to biliary reflux, and the second problem is the decubitus lesion in the duodenal bulb caused by the distal edge[108,114]. Another type of stent is uncovered biodegradable stents.…”

Section: Anastomotic Leaks and Fistulasmentioning

confidence: 99%

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Souto-Rodríguez¹,

Alvarez-Sánchez²

2017

WJGE

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Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

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Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy

Cited by 32 publications

References 13 publications

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

A novel fully covered double-bump stent for staple line leaks after bariatric surgery: a retrospective analysis

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

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

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