title: A novel dedicated endoscopic stent for staple-line leaks after laparoscopic sleeve gastrectomy: a case series.
abstract: BACKGROUND
  Staple-line leak is the most serious complication of laparoscopic sleeve gastrectomy (LSG) occurring in .5-7% of cases. Patients with this complication are often managed with an esophageal covered, self-expandable metal stent positioned at endoscopy. Unfortunately, migration of these stents has been reported in 30-50% of cases. A novel fully-covered, self-expanding metal stent (Megastent), specifically designed for post-LSG leaks is now available. The objective of this study was to describe the first case series of patients with a staple-line leak after LSG who were endoscopically managed with such a novel stent.
  
  
  METHODS
  Four patients who developed a staple-line leak after LSG were treated by positioning a Megastent at endoscopy. The stents were removed after 8 weeks.
  
  
  RESULTS
  A complete leak repair was achieved in all patients. No stent migration occurred. Prokinetic therapy was needed to treat vomiting episodes during stent presence. At endoscopic evaluation after stent removal, a decubitus lesion at the distal part of the duodenal bulb was observed.
  
  
  CONCLUSIONS
  These preliminary results would suggest the use of the Megastent as an option for stenting of a staple-line leak after LSG. Further studies are still necessary.
authors.affiliation: Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, Federico II University, Naples, Italy. Electronic address: giuseppe.galloro@unina.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
authors.affiliation: Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, Federico II University, Naples, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Magno
authors.affiliation: Department of Advanced Bio-Medical Sciences, General Surgery Unit, Federico II University, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo S. Agostino Estense Hospital, Modena, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Manta
authors.affiliation: Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Department of Clinical Medicine and Surgery, General and Bariatric Surgery Unit; Federico II University, Naples, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015607:Stents; D017792:Surgical Stapling / Q000009:adverse effects*
keywords: Endoscopic therapy; Obesity; Postsurgical leak; Sleeve gastrectomy