Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for Treatment of Leaks Following Sleeve Gastrectomy |
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Authors: | Gianfranco Donatelli Stefano Ferretti Bertrand M Vergeau Parag Dhumane Jean-Loup Dumont Serge Derhy Thierry Tuszynski Stavros Dritsas Alessio Carloni Jean-Marc Catheline Guillaume Pourcher Ibrahim Dagher Bruno Meduri |
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Institution: | 1. Unité d’Endoscopie Interventionnelle, H?pital Privé des Peupliers, Générale de Santé, 8 Place de l’Abbé G. Henocque, 75013, Paris, France 2. Service de Chirurgie Digestive Minimale-Invasive, H?pital Universitaire Antoine Béclère-APHP, 157 Rue de la Porte de Trivaux, 92140, Clamart, France 3. Department of General and Laparoscopic Surgery, Lilavati Hospital and Research Centre, 791, Chapel Rd, Bandra Reclamation, Bandra West, Mumbai, MH, 400050, India 4. Unité de Radiologie Interventionnelle, H?pital Privé des Peupliers, Générale de Santé, 8 Place de l’Abbé G. Henocque, 75013, Paris, France 5. Service d’ Hepatologie, H?pital Universitaire Jean Minjoz, 3 Boulevard Alexandre Fleming, 25030, Besan?on, France 6. Service de Chirurgie Viscérale, H?pital Privé des Peupliers, Générale de Santé, 8 Place de l’Abbé G. Henocque, 75013, Paris, France 7. Service de Chirurgie Viscérale, Centre H?spitalier de Saint-Denis, 2 Rue Docteur Delafontaine, 93200, Saint-Denis, France
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Abstract: | Background Endoscopic treatment of gastric leaks (GL) following sleeve gastrectomy (SG) involves different techniques; however, standard management is not yet established. We report our experience about endoscopic internal drainage of leaks using pigtail stents coupled with enteral nutrition (EDEN) for 4 to 6 weeks until healing is achieved. Methods In 21 pts (18 F, 41 years), one or two plastic pigtail stents were delivered across the leak 25.6 days (4–98) post-surgery. In all patients, nasojejunal tube was inserted. Check endoscopy was done at 4 to 6 weeks with either restenting if persistent leak, or removal if no extravasation of contrast in peritoneal cavity, or closure with an Over-the-Scope Clip® (OTSC®) if contrast opacifying the crossing stent without concomitant peritoneal extravasation. Results Twenty-one out of 21 (100 %) patients underwent check endoscopy at average of 30.15 days (26–45) from stenting. In 7/21 (33.3 %) patients leak sealed, 2/7 needed OTSC®. Second check endoscopy, 26.7 days (25–42) later, showed sealed leak in 10 out 14; 6/10 had OTSC®. Four required restenting. One patient, 28 days later, needed OTSC®. One healed at 135 days and another 180 days after four and seven changes, respectively. One patient is currently under treatment. In 20/21 (95.2 %), GL have healed with EID treatment of 55.5 days (26–?180); all are asymptomatic on a normal diet at average follow-up of 150.3 days (20–276). Conclusions EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required. |
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