title: Novel oesophago-gastro-duodenal stenting for gastric leaks after laparoscopic sleeve gastrectomy.
abstract: The management of gastric leak after laparoscopic sleeve gastrectomy (LSG) can be complex and challenging. Whilst operative interventions are mostly complicated and reserved for unstable or refractory cases, endoscopic self-expandable metal stenting (SEMS) is increasingly preferred as a safer treatment option. Yet, SEMS carries the problems of frequent stent migration and inconsistent healing as ordinary SEMS is designed mainly for stenotic disease. We hereby present two cases of early and chronic post-LSG leakage that were respectively failed to be treated by surgery and ordinary SEMS but were successfully managed by a dedicated extra-long oesophago-gastro-duodenal stent. In oesophago-gastro-duodenal stenting, the characteristics of extra-long stent length allow total gastric exclusion between the mid-oesophagus and the first part of duodenum to prevent stent migration and to equalise high pressure gradient within the gastric sleeve to promote fistula healing.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Shirley Yuk-Wah
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Simon Kin-Hung
authors.initials: SK
authors.lastname: Wong
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address: endersng@surgery.cuhk.edu.hk.
authors.forename: Enders Kwok-Wai
authors.initials: EK
authors.lastname: Ng
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D050110:Bariatric Surgery / Q000009:adverse effects*; D002681:China; D004386:Duodenum / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D015607:Stents; D013270:Stomach / Q000601:surgery*; D000068878:Trastuzumab
chemical_list: D000068878:Trastuzumab
keywords: Bariatric surgery; Endoscopy; Gastric fistula; Sleeve gastrectomy; Stents