Gastric fistula is one of the most dreadful events after sleeve gastrectomy (SG). That is justified by the fact that there is no consensus regarding what would be the optimal management for this morbid event. In the recent years, authors have pointed to the benefits of endoscopic interventions, with the implantation of stents, aiming to relieve the intragastric pressure and facilitate the natural closure of the fistulous path. However, the literature on this topic is scarce and the results are quite heterogenous. This article reviewed the use of endoscopic stents combined or not with surgical or percutaneous drainage in the treatment of gastric fistulas after SG, highlighting the scientific evidence that exists and discussing the need for further research on this topic.
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References
1.
SjostromL, LindroosAK, PeltonenM, TorgersonJ, BouchardC, CarlssonB, et al.Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med, 2004; 351:2683–2693.
2.
SjostromL. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond), 2008; 32(Suppl 7):S93–S97.
3.
RibaricG, BuchwaldJN, McGlennonTW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg, 2014; 24:437–455.
4.
NationalHeart, Lung, and BloodInstitute, National Institutes ofHealth. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 6(Suppl 2):51S–209S.
JurowichC, ThalheimerA, SeyfriedF, FeinM, BenderG, GermerCT, et al.Gastric leakage after sleeve gastrectomyclinical presentation and therapeutic options. Langenbecks Arch Surg, 2011; 396:981–987.
8.
ASMBS Clinical Issues Committee. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis, 2012; 8:e21–e26.
9.
AuroraAR, KhaitanL, SaberAA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc, 2012; 26:1509–1515.
10.
Abou RachedA, BasileM, El MasriH. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol, 2014; 20:13904–13910.
11.
KimJ, AzaguryD, EisenbergD, DeMariaE, Campos GM; American Society for Metabolic and Bariatric Surgery Clinical IssuesCommittee. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis, 2015; 11:739–748.
12.
YehoshuaRT, EidelmanLA, SteinM, FichmanS, MazorA, ChenJ, et al.Laparoscopic sleeve gastrectomy-volume and pressure assessment. Obes Surg, 2008; 18:1083–1088.
13.
SerraC, BaltasarA, AndreoL, PérezN, BouR, BengocheaM, et al.Treatment of gastric leaks with coated self expanding stents after sleeve gastrectomy. Obes Surg, 2007; 17:866–872.
14.
AlazmiW, Al-SabahS, AliDAM, AlmazeediS. Treating sleeve gastrectomy leak with endoscopic stenting: the Kuwaiti experience and review of recent literature. Surg Endosc, 2014; 28:3425–3428.
15.
AlmadiMA, BamihrizF, AlharbiO, AzzamN, AljammazA, EltayebM, et al.Use of self-expandable metal stents in the treatment of leaks complicating laparoscopic sleeve gastrectomy: a cohort study. Obes Surg, 2018; 28:1562–1570.
16.
De AretxabalaX, LeonJ, WiedmaierG, TuruI, OvalleC, MaluendaF, et al.Gastric leak after sleeve gastrectomy: analysis of its management. Obes Surg, 2011; 21:1232–1237.
17.
FishmanS, ShnellM, GluckN, MeirsdorfS, Abu-AbeidS, SantoE. Use of sleeve-customized self-expandable metal stents for the treatment of staple-line leakage after laparoscopic sleeve gastrectomy. Gastrointest Endosc, 2015; 81:1291–1294.
18.
GarofaloF, Noreau-NguyenM, DenisR, AtlasH, GarneauP, PescarusR. Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents. Surg Obes Relat Dis, 2017; 13:925–932.
19.
JuzaRM, HaluckRS, PauliEM, RogersAM, WonEJ, LynsueJR. Gastric sleeve leak: a single institution's experience with early combined laparoendoscopic management. Surg Obes Relat Dis, 2015; 11:60–64.
20.
KlimczakT, KlimczakJ, SzewczykT, JanczakP, JurałowiczP. Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents. Surg Endosc, 2018; 32:2038–2045.
21.
Martin del CampoSE, MikamiDJ, NeedlemanBJ, NoriaSF. Endoscopic stent placement for treatment of sleeve gastrectomy leak: a single institution experience with fully covered stents. Surg Obes Relat Dis, 2018; 14:453–461.
22.
MoonRC, ShahN, TeixeiraAF, JawadMA. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis, 2015; 11:54–59.
23.
MontuoriM, BenavoliD, D'ugoS, Di BenedettoL, BianciardiE, GaspariAL, et al.Integrated approaches for the management of staple line leaks following sleeve gastrectomy. J Obes, 2017; 2017:4703236.
24.
Rosenthal RJ; International Sleeve Gastrectomy Expert Panel; DiazAA, ArvidssonD, BakerRS, BassoN, et al.International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis, 2012; 8:8–19.
25.
NedelcuM, ManosT, CotirletA, NoelP, GagnerM. Outcome of leaks after sleeve gastrectomy based on a new algorithm addressing leak size and gastric stenosis. Obes Surg, 2015; 25:559–563.
26.
NimeriA, IbrahimM, MaasherA, Al HadadM. Management algorithm for leaks following laparoscopic sleeve gastrectomy. Obes Surg, 2016; 26:21–25.
27.
QuezadaN, MaizC, DarochD, FunkeR, SharpA, BozaC, et al.Effect of early use of covered self-expandable endoscopic stent on the treatment of postoperative stapler line leaks. Obes Surg, 2015; 25:1816–1821.
SouthwellT, LimTH, OgraR. Endoscopic therapy for treatment of staple line leaks post-laparoscopic sleeve gastrectomy (LSG): experience from a large bariatric surgery centre in New Zealand. Obes Surg, 2016; 26:1155–1162.
30.
TanJT, KariyawasamS, WijeratneT, ChandraratnaHS. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg, 2010; 20:403–409.
31.
TringaliA, BoveV, PerriV, LandiR, FamiliariP, BoškoskiI, et al.Endoscopic treatment of post-laparoscopic sleeve gastrectomy leaks using a specifically designed metal stent. Endoscopy, 2017; 49:64–68.
