title: Endoscopic Internal Drainage with Enteral Nutrition (EDEN) for treatment of leaks following sleeve gastrectomy.
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.
authors.affiliation: Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Générale de Santé, 8 Place de l'Abbé G. Henocque, 75013, Paris, France, donatelligianfranco@gmail.com.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferretti
authors.forename: Bertrand M
authors.initials: BM
authors.lastname: Vergeau
authors.forename: Parag
authors.initials: P
authors.lastname: Dhumane
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Dumont
authors.forename: Serge
authors.initials: S
authors.lastname: Derhy
authors.forename: Thierry
authors.initials: T
authors.lastname: Tuszynski
authors.forename: Stavros
authors.initials: S
authors.lastname: Dritsas
authors.forename: Alessio
authors.initials: A
authors.lastname: Carloni
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Catheline
authors.forename: Guillaume
authors.initials: G
authors.lastname: Pourcher
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dagher
authors.forename: Bruno
authors.initials: B
authors.lastname: Meduri
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003287:Contrast Media; D004322:Drainage / Q000379:methods*; D004724:Endoscopy; D004750:Enteral Nutrition; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D015607:Stents; D017792:Surgical Stapling
chemical_list: D003287:Contrast Media