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Obesity Surgery
Published in: Obesity Surgery 3/2020

01-03-2020 | Bariatric Surgery | How I Do It

Endoscopic Stents in the Management of Bariatric Complications: Our Algorithm and Outcomes

Authors: Shyam Vedantam, Jay Roberts

Published in: Obesity Surgery | Issue 3/2020

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Abstract

Background

Endoscopic techniques can provide an alternative to surgery in the management of post-bariatric surgery complications such as leaks, strictures, fistulas, and erosion of transgastric and adjustable gastric bands. Endoscopically placed stents can also be used to manage gastric perforations secondary to NSAIDS or perforated marginal ulcers following gastric bypass surgery. Additionally, stents can be used in conjunction with operative intervention to decrease the risk of more deleterious complications that could require additional operations.

Objectives

The objective of this report is to describe our private practice experience in managing bariatric procedure complications with fully covered endoscopic stents. We present the algorithm we use in the application of endoscopic stents in the management of complications following bariatric surgery.

Setting

Private practice, Single provider, Tertiary Referral Center, USA

Methods

Data for all patients who underwent endoscopic stent placement for complications after various bariatric surgeries (Roux-en-Y gastric bypass, gastric sleeve, lap band, and vertical banded gastroplasty) performed by several different surgeons between July 2015 and December 2018 at a single private practice were retrospectively reviewed. Patient’s medical history, perioperative information, stent placement details, outcomes, and subsequent interventions were reviewed and analyzed.

Results

Thirty-five patients who were treated with endoscopic stents after bariatric surgery were identified. Complications after bariatric surgery treated with stenting included staple line leaks, anastomotic leaks, strictures, marginal ulcer perforations, gastrogastric fistula, and lap band erosion repairs. Mean duration of each stent round also varied. Resolution occurred in 33 patients (94.3%). Stent migration occurred in seven patients (20%) and in eight of 51 stents placed (15.7%). Two patients ultimately required revision surgery, though only one was related to stent (2.9%).

Conclusions

Our findings suggest that foregut stents deployed according to our algorithm can facilitate healing of anastomotic leaks, staple line leaks, and marginal ulcer perforations. Furthermore, stent placement can also bolster tenuous repairs of band erosion sites, repairs staple line failure, and manages leaks at band erosion repair sites. Endoscopic stents can also be utilized to augment both balloon and savory dilation of gastric anastomoses and gastric sleeve strictures. Stents should be clipped proximally and distally to minimize the risk of migration.
Literature
1.
Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO Global Registry Report 2018. Obes Surg. 2018.
2.
Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66(Suppl 2):7–12.PubMed
3.
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384:766–81.PubMedPubMedCentral
4.
Martins C, Strømmen M, Stavne OA, et al. Bariatric surgery versus lifestyle interventions for morbid obesity--changes in body weight, risk factors and comorbidities at 1 year. Obes Surg. 2011;21:841–9.PubMed
5.
Sjöström L, Lindroos AK, Peltonen M, et al. Wedel H; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMed
6.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMed
7.
8.
Walsh C, Karmali S. Endoscopic management of bariatric complications: a review and update. World J Gastrointest Endosc. 2015;7(5):518–23.PubMedPubMedCentral
9.
Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-Y gastric bypass. Br J Surg. 2014;101:417–23.PubMedPubMedCentral
10.
Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.PubMed
11.
12.
Eisendrath P, Deviere J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol. 2015;12(12):701–10.PubMed
13.
Spaander MC, Baron TH, Siersema PD, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48(10):939–48.PubMed
14.
Kim J, Azagury D, Eisenberg D, et al. American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48.PubMed
15.
Carrodeguas L, Szomstein S, Zundel N, et al. Gastrojejunal anastomotic strictures following laparoscopic Roux-en-Y gastric bypass surgery: analysis of 1291 patients. Surg Obes Related Dis. 2006;2(2):92–7.
16.
Joo MK. Endoscopic approach for major complications of bariatric surgery. Clin Endosc. 2017;50(1):31–41.PubMed
17.
de Moura EGH, Orso IRB, Aurelio EF, et al. Factors associated with complications or failure of endoscopic balloon dilation of anastomtic stricture secondary to Roux-en-Y gastric bypass surgery. Surg Obs Related Dis. 2016;12(3):582–6.
18.
Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):287–93.PubMed
19.
Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.PubMed
20.
van den Berg MW, Kerbert AC, van Soest EJ, et al. Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula. Dis Esophagus. 2016;29(6):572–9.PubMed
21.
Shehab H, Abdallah E, Gawdat K, et al. Large bariatric-specific stents and over-the-scope clips in the management of post-bariatric surgery leaks. Obes Surg. 2018;28(1):15–24.PubMed
22.
Jafri SA, Roberts J, Smith A. Successful management of early gastrogastric fistula using fully covered esophageal stent. SAORD. 2018;13:1911–3.
23.
Senousy BE, Gupte AR, Draganov PV, et al. Fully covered Alimaxx esophageal metal stents in the endoscopic treatment of benign esophageal disease. Dig Dis Sci. 2010;55(12):3399–403.PubMed
24.
Donatelli G, Dhumane P, Perretta S, et al. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg. 2012;8(4):118–24.PubMedPubMedCentral
25.
Shehab HM, Hakky SM, Gawdat KA. An endoscopic strategy combining mega stents and over-the-scope clips for the management of post-bariatric surgery leaks and fistulas (with video). Obes Surg. 2016;26(5):941–8.PubMed
26.
Singer JL, Aryaie AH, Fayezizadeh M, et al. Predictive factors for the migration of endoscopic self-expanding metal stents placed in the foregut. Surg Innov. 2017;24(4):353–7.PubMed
27.
Rieder E, Asari R, Paireder M, et al. Endoscopic stent suture fixation for prevention of esophageal stent migration during prolonged dilation for achalasia treatment. Dis Esophagus. 2017;30(4):1–6.PubMed
28.
Vanbiervliet G, Filippi J, Karimdjee BS, et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc. 2012;26(1):53–9.PubMed
29.
Kato H, Fukuchi M, Miyazaki T, et al. Endoscopic clips prevent self-expandable metallic stent migration. Hepatogastroenterology. 2007;54(77):1388–90.PubMed
30.
Rieder E, Dunst CM, Martinec DV, et al. Endoscopic suture fixation of gastrointestinal stents: proof of biomechanical principles and early clinical experience. Endoscopy. 2012;44(12):1121–6.PubMed
31.
Wilcox VT, Huang AY, Tarig N, et al. Endoscopic suture fixation of self-expanding metallic stents with and without submucosal injection. Surg Endosc. 2015;29(1):24–9.PubMed
32.
Rebibo L, Hakim S, Brazier F, et al. New endoscopic technique for the treatment of large gastric fistula or gastric stenosis associated with gastric leaks after sleeve gastrectomy. Sug Obes Relat Dis. 2016;12(8):1577–84.
33.
Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25(7):1293–301.PubMed
34.
Donatelli G, Dumont JL, Dhumane P, et al. Double pigtail stent insertion for healing of leaks following Roux-en-Y gastric bypass. our experience (with videos). Obes Surg. 2017;27(2):530–5.PubMed
35.
Cosse C, Rebibo L, Brazier F, et al. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy. Br J Surg. 2018;105(5):570–7.PubMed
36.
Lorenzo D, Guilbaud T, Gonzalez JM, et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc. 2018;87(2):429–37.PubMed
37.
Romano L, Giuliani A, Cianca G, et al. A case of intrasplenic displacement of an endoscopic double-pigtail stent as a treatment for laparoscopic sleeve gastrectomy leak. Int J Surg Case Rep. 2018;53:367–9.PubMedPubMedCentral
38.
Donatelli G, Airinei G, Poupardin E, et al. Double-pigtail stent migration invading the spleen: rare potentially fatal complication of endoscopic internal drainage for sleeve gastrectomy leak. Endoscopy. 2016;48(S01):E74–5.PubMed
39.
Genser L, Pattou F, Calazzo R. Splenic abscess with portal venous gas caused by intrasplenic migration of an endoscopic double pigtail drain as a treatment of post-sleeve gastrectomy fistula. Surg Obes Relat Dis. 2016;12(1):e1–3.PubMed
40.
Seven G, Irani S, Ross AS, et al. Partially versus fully covered self-expanding metal stents for benign and malignant esophageal conditions: a single center experience. Surg Endosc. 2013;27(6):2185–92.PubMed
41.
van Boeckel PG, Dua KS, Weusten BL, et al. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol. 2012;12:19.PubMedPubMedCentral
42.
van Heel NC, Haringsma J, Wijnhoven BP, et al. Endoscopic removal of self-expandable metal stents from the esophagus (with video). Gastrointest Endosc. 2011;74(1):44–50.PubMed
43.
Ngamruengphong S, Sharaiha R, Sethi A, et al. Fully covered metal stents with endoscopic suturing vs partially covered metal stents for benign upper gastrointestinal diseases: a comparative study. Endosc Int Open. 2018;8(2):E217–23.
44.
Gangloff A, Lecleire S, Di Fiore A, et al. Antonietti, Michel P. Fully versus partially covered self-expandable metal stents in benign esophageal strictures. Dis Esophagus. 2015;28(7):678–83.PubMed
Metadata
Title
Endoscopic Stents in the Management of Bariatric Complications: Our Algorithm and Outcomes
Authors
Shyam Vedantam
Jay Roberts
Publication date
01-03-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 3/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04284-7

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