Endoscopic internal drainage for the management of leak,fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients |
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| Authors: | Gianfranco Donatelli Andrea Spota Fabrizio Cereatti Stefano Granieri Ibrahim Dagher Renaud Chiche Jean-Marc Catheline Guillaume Pourcher Lionel Rebibo Daniela Calabrese Simon Msika Carmelisa Dammaro Hadrien Tranchart Panagiotis Lainas Thierry Tuszynski Filippo Pacini Roberto Arienzo Jean-Marc Chevallier Jean-Loup Dumont |
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| Institution: | 1. Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France;2. Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy;3. Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy;4. General Surgery Unit, ASST-Vimercate, Vimercate, Italy;5. Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France;6. Service de Chirurgie digestive et de l’Obésité, Clinique Geoffry Saint Hilaire, Paris, France;7. Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France;8. Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France;9. Service de chirurgie digestive ?sogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France;10. Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France;11. Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France;12. Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France;13. Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d’Orsay, Orsay, France;14. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France;15. Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France;p. Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France;q. Service de chirurgie digestive et obésité, Clinique Bizet, Paris, France |
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| Abstract: | BackgroundEndoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases.ObjectivesTo evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.SettingRetrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center.MethodsEID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)–guided deployment of DPS or lumen apposing metal stents.ResultsA total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818).ConclusionEarly EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results. |
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| Keywords: | Double pigtails Leak Fistula Sleeve gastrectomy LAMS EUS Collection Endoscopic internal drainage |
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