title: Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery.
abstract: BACKGROUND
  Reoperations for complications of bariatric surgery are associated with high morbidity and mortality. It is not known whether endoscopic treatment may reduce reoperation rates.
  
  
  METHODS
  Twenty-one patients underwent endoscopic treatment for persisting large anastomotic leaks before considering redo surgery. Eight patients had a gastric bypass, eight had a sleeve gastrectomy combined with a duodenal switch (SDS), four had a sleeve gastrectomy alone, and one had a Scopinaro procedure (biliopancreatic diversion). Fistulas were gastrocutaneous in 15 patients, duodenocutaneous in 2, gastroperitoneal in 3, and gastrobronchial in 1. Partially covered self-expanding metal stents (SEMSs) were used, followed by additional endoscopic procedures if the SEMS failed. SEMSs were removed by traction alone or by insertion of a self-expanding plastic stent (SEPS) followed by extraction of both stents together.
  
  
  RESULTS
  SEMS insertion led to 62 % (13/21) primary closures. Complementary endoscopic treatment led to 4 secondary closures. Total success rate was 81 % (17/21). Three patients in whom SEMSs failed underwent reoperation but died during postoperative follow-up; one patient died from pulmonary embolism before SEMS extraction. The success rates of endotherapy were 100 % (8/8) in the gastric bypass group, 62.5 % (5/8) in the SDS group, 75 % (3/4) in the sleeve gastrectomy group, and 100 % (1/1) for the Scopinaro procedure. Gastrocutaneous fistulas on sleeve sutures were successfully treated in 60 % of cases (6/10), while other anastomotic fistulas were successfully treated in 100 % of cases (11/11) ( P = 0.0351).
  
  
  CONCLUSIONS
  Endoscopic treatment using SEMSs for complications of bariatric surgery is feasible. Healing of severe leaks was obtained in 81 % (17/21) of patients, avoiding high-risk reintervention. Gastrocutaneous fistulas on a sleeve suture are the most difficult condition to treat.
authors.affiliation: Medical Surgical Department of Gastroenterology and Hepatopancreatology, Erasme Hospital, UniversitA libre de Bruxelles (U.L.B.), Brussels, Belgium. peisendr@ulb.ac.be
authors.forename: P
authors.initials: P
authors.lastname: Eisendrath
authors.forename: M
authors.initials: M
authors.lastname: Cremer
authors.forename: J
authors.initials: J
authors.lastname: Himpens
authors.forename: G-B
authors.initials: GB
authors.lastname: Cadière
authors.forename: O
authors.initials: O
authors.lastname: Le Moine
authors.forename: J
authors.initials: J
authors.lastname: Devière
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005747:Gastric Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000295:instrumentation*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible