Skip to main content
SpringerLink
Log in

Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Endoscopic stents are successful in the management of surgical leaks; however, stent migration remains a significant problem. In this study, we present our approach depending on a large bariatrics-specific stent (Mega stent) and over-the-scope clips in the management of post-bariatric surgery leaks.

Methods

A retrospective analysis of all patients with post-bariatric surgery leaks treated at our institution using an approach reliant on Mega stents and over-the-scope clips was conducted. Potential factors associated with procedure success and occurrence of complications were also evaluated.

Results

A total of 81 stents were inserted in 62 patients with post-bariatric surgery leaks, 46 sleeve gastrectomies (73%) and 16 Roux-en-Y gastric bypass (27%). Over-the-scope clips were applied in 29 patients (46%). Leak closure was achieved in 51 patients (82%). Median number of procedures per patient was 3 (range 2–8). Complications included the following: stent migration (11/62, 18%), intolerance necessitating premature removal (7/62, 11%), esophageal stricture (8/62, 13%), bleeding (4/62, 6%), perforation (4/62, 6%). One stent-induced mortality was encountered (bleeding). The presence of open surgery (vs laparoscopic) was significantly associated with the occurrence of stent-induced complications (p 0.002).

Conclusion

The approach combining Mega stents and over-the-scope clips is highly effective in the management of post-bariatric surgery leaks and is associated with a low rate of stent migration and a low number of procedures and stents per patient. Mega stents, however, should be used with great caution due to the significant morbidity associated with their use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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;75:287–93.

    Article  PubMed  Google Scholar 

  4. Leenders BJ, Stronkhorst A, Smulders FJ, et al. Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital. Surg Endosc. 2013;27:2751–9.

    Article  PubMed  Google Scholar 

  5. Orive-Calzada A, Calderón-García Á, Bernal-Martínez A, et al. Closure of benign leaks, perforations, and fistulas with temporary placement of fully covered metal stents: a retrospective analysis. Surg Laparosc Endosc Percutan Tech. 2014;24:528–36.

    PubMed  Google Scholar 

  6. 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;26:941–8.

    Article  PubMed  Google Scholar 

  7. Willingham FF, Buscaglia JM. Endoscopic management of gastrointestinal leaks and fistulae. Clin Gastroenterol Hepatol. 2015;13:1714–21.

    Article  PubMed  Google Scholar 

  8. Kumar N, Thompson C. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am. 2013;23:123–36.

    Article  PubMed  Google Scholar 

  9. van Halsema EE, van Hooft JE. Clinical outcomes of self-expandable stent placement for benign esophageal diseases: a pooled analysis of the literature. World J Gastrointest Endosc. 2015;7:135–53.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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;73:890–9.

    Article  PubMed  Google Scholar 

  11. Feith M, Gillen S, Schuster T, et al. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol. 2011;9:202–10.

    Article  PubMed  Google Scholar 

  12. Bège T, Emungania O, Vitton V, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc. 2011;73:238–44.

    Article  PubMed  Google Scholar 

  13. Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25:1293–301.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology Department, Kasr-Alainy School of Medicine, Cairo University, Cairo, 11562, Egypt

    Hany Shehab

  2. General Surgery Department, Mansoura School of Medicine, Mansoura University, Mansoura, Egypt

    Emad Abdallah

  3. General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Khaled Gawdat

  4. Biostatistics and Epidemiology Department, National Cancer Institute, Cairo, Egypt

    Inas Elattar

Authors
  1. Hany Shehab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emad Abdallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khaled Gawdat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inas Elattar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hany Shehab.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. Abdallah and Dr. Gawdat and dr. Elattar have no relevant conflicts of interest to disclose.

Dr. Shehab had consulted for stent designs not included in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 28, 15–24 (2018). https://doi.org/10.1007/s11695-017-2808-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2808-1

Keywords

Search

Navigation