The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery

Carlos A. Puig, Tarek M. Waked, Todd H. Baron, Louis M. Wong Kee Song, Jessica Gutierrez, Michael G. Sarr

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Methods: We treated 21 patients including 5 with chronic staple line leaks/fistulas (4 from the gastric sleeve after biliopancreatic diversion with duodenal switch [BPD/DS] and 1 after removal of an eroding laparoscopic adjustable gastric band) and 16 with chronic anastomotic strictures (15 at the gastrojejunostomy after Roux-en-Y gastric bypass and 1 at the duodenoileal anastomosis after BPD/DS). Patients with early leaks or anastomotic strictures were excluded.

Results: All but one of these patients had been referred to our institution after chronic treatment elsewhere was unsuccessful with prior stent placement for fistulas or multiple endoscopic dilations for strictures. Their bariatric operations had been performed a mean of 386 days beforehand. Stent placement was performed successfully in all patients without complications but was successful in only 4 of 21 patients (19%)-2 with chronic fistulas and 2 with chronic anastomotic strictures. Stent migration occurred in 10 patients (47%); the migrated stents were removed/replaced endoscopically in 7 patients but required elective operative removal in 3 with concomitant correction of the leak, fistula, or anastomotic stricture; none were operated emergently.

Conclusion: Only 4 of 21 patients with a chronic persistent leak or anastomotic stricture were treated definitively using a SEMS. Although endoluminal stents may not lead to resolution of a chronic leak or stricture, SEMS may suppress ongoing sepsis and allow patients to undergo nutritional resuscitation orally before operative correction. (Surg Obes Relat Dis 2014;10:613619.).

Background: The use of endoluminal stents has been proposed for the management of fistulas and anastomotic strictures after bariatric surgery. The objective of our study was to determine the success of endoscopically placed, self-expandable metal stents (SEMS) in bariatric patients specifically with either chronic persistent anastomotic or staple line leaks/fistulas or chronic, persistent anastomotic strictures.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume10
Issue number4
DOIs
StatePublished - Jul 1 2014

Fingerprint

Bariatric Surgery
Stents
Pathologic Constriction
Fistula
Biliopancreatic Diversion
Bariatrics
Anastomotic Leak
Gastric Bypass
Gastric Fistula
Resuscitation
Dilatation
Sepsis
Stomach

Keywords

  • Anastomotic leaks
  • Anastomotic strictures
  • metal stents
  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Staple line leaks

ASJC Scopus subject areas

  • Surgery

Cite this

The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. / Puig, Carlos A.; Waked, Tarek M.; Baron, Todd H.; Wong Kee Song, Louis M.; Gutierrez, Jessica; Sarr, Michael G.

In: Surgery for Obesity and Related Diseases, Vol. 10, No. 4, 01.07.2014, p. 613-619.

Research output: Contribution to journalArticle

Puig, Carlos A. ; Waked, Tarek M. ; Baron, Todd H. ; Wong Kee Song, Louis M. ; Gutierrez, Jessica ; Sarr, Michael G. / The role of endoscopic stents in the management of chronic anastomotic and staple line leaks and chronic strictures after bariatric surgery. In: Surgery for Obesity and Related Diseases. 2014 ; Vol. 10, No. 4. pp. 613-619.
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AU - Baron, Todd H.

AU - Wong Kee Song, Louis M.

AU - Gutierrez, Jessica

AU - Sarr, Michael G.

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N2 - Methods: We treated 21 patients including 5 with chronic staple line leaks/fistulas (4 from the gastric sleeve after biliopancreatic diversion with duodenal switch [BPD/DS] and 1 after removal of an eroding laparoscopic adjustable gastric band) and 16 with chronic anastomotic strictures (15 at the gastrojejunostomy after Roux-en-Y gastric bypass and 1 at the duodenoileal anastomosis after BPD/DS). Patients with early leaks or anastomotic strictures were excluded.Results: All but one of these patients had been referred to our institution after chronic treatment elsewhere was unsuccessful with prior stent placement for fistulas or multiple endoscopic dilations for strictures. Their bariatric operations had been performed a mean of 386 days beforehand. Stent placement was performed successfully in all patients without complications but was successful in only 4 of 21 patients (19%)-2 with chronic fistulas and 2 with chronic anastomotic strictures. Stent migration occurred in 10 patients (47%); the migrated stents were removed/replaced endoscopically in 7 patients but required elective operative removal in 3 with concomitant correction of the leak, fistula, or anastomotic stricture; none were operated emergently.Conclusion: Only 4 of 21 patients with a chronic persistent leak or anastomotic stricture were treated definitively using a SEMS. Although endoluminal stents may not lead to resolution of a chronic leak or stricture, SEMS may suppress ongoing sepsis and allow patients to undergo nutritional resuscitation orally before operative correction. (Surg Obes Relat Dis 2014;10:613619.).Background: The use of endoluminal stents has been proposed for the management of fistulas and anastomotic strictures after bariatric surgery. The objective of our study was to determine the success of endoscopically placed, self-expandable metal stents (SEMS) in bariatric patients specifically with either chronic persistent anastomotic or staple line leaks/fistulas or chronic, persistent anastomotic strictures.

AB - Methods: We treated 21 patients including 5 with chronic staple line leaks/fistulas (4 from the gastric sleeve after biliopancreatic diversion with duodenal switch [BPD/DS] and 1 after removal of an eroding laparoscopic adjustable gastric band) and 16 with chronic anastomotic strictures (15 at the gastrojejunostomy after Roux-en-Y gastric bypass and 1 at the duodenoileal anastomosis after BPD/DS). Patients with early leaks or anastomotic strictures were excluded.Results: All but one of these patients had been referred to our institution after chronic treatment elsewhere was unsuccessful with prior stent placement for fistulas or multiple endoscopic dilations for strictures. Their bariatric operations had been performed a mean of 386 days beforehand. Stent placement was performed successfully in all patients without complications but was successful in only 4 of 21 patients (19%)-2 with chronic fistulas and 2 with chronic anastomotic strictures. Stent migration occurred in 10 patients (47%); the migrated stents were removed/replaced endoscopically in 7 patients but required elective operative removal in 3 with concomitant correction of the leak, fistula, or anastomotic stricture; none were operated emergently.Conclusion: Only 4 of 21 patients with a chronic persistent leak or anastomotic stricture were treated definitively using a SEMS. Although endoluminal stents may not lead to resolution of a chronic leak or stricture, SEMS may suppress ongoing sepsis and allow patients to undergo nutritional resuscitation orally before operative correction. (Surg Obes Relat Dis 2014;10:613619.).Background: The use of endoluminal stents has been proposed for the management of fistulas and anastomotic strictures after bariatric surgery. The objective of our study was to determine the success of endoscopically placed, self-expandable metal stents (SEMS) in bariatric patients specifically with either chronic persistent anastomotic or staple line leaks/fistulas or chronic, persistent anastomotic strictures.

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KW - Anastomotic strictures

KW - metal stents

KW - Roux-en-Y gastric bypass

KW - Sleeve gastrectomy

KW - Staple line leaks

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