Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for Treatment of Leaks Following Sleeve Gastrectomy
- 6 June 2014
- journal article
- Published by Springer Science and Business Media LLC in Obesity Surgery
- Vol. 24 (8), 1400-1407
- https://doi.org/10.1007/s11695-014-1298-7
Abstract
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. 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. 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). EDEN is a promising therapeutic approach for treating leaks following SG. Multiple endoscopic sessions may be required.Keywords
This publication has 15 references indexed in Scilit:
- Late Complication of Laparoscopic Sleeve GastrectomyCase Reports in Gastrointestinal Medicine, 2013
- Single-Stage Operative Management of Laparoscopic Sleeve Gastrectomy Leaks Without Endoscopic Stent PlacementObesity Surgery, 2013
- Plaies opératoires complètes de la voie biliaire principale: reconstruction extra-anatomique par rendez-vous radio-endoscopiqueEndoscopy, 2013
- Gastric Leak After Laparoscopic Sleeve Gastrectomy: Early Covered Self-Expandable Stent Reduces Healing TimeObesity Surgery, 2013
- Stent treatment for fistula after obesity surgery: results in 47 consecutive patientsSurgical Endoscopy, 2012
- Is There a Place for Pigtail Drains in the Management of Gastric Leaks After Laparoscopic Sleeve Gastrectomy?Obesity Surgery, 2012
- Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaksJournal of Minimal Access Surgery, 2012
- Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and preventionObesity Surgery, 2011
- Endoscopic treatment of postoperative enterocutaneous fistulas after bariatric surgery with the use of a fistula plug: report of five casesEndoscopy, 2009
- Endoscopic Drainage of Pancreatic Pseudocysts: Long-Term Outcome and Procedural Factors Associated with Safe and Successful TreatmentEndoscopy, 2005