title: New endoscopic technique for the treatment of large gastric fistula or gastric stenosis associated with gastric leaks after sleeve gastrectomy.
abstract: BACKGROUND
  Covered stent (CS) is required when gastric leak (GL) after sleeve gastrectomy is combined with gastric stenosis (GS) or when a large (>2 cm in diameter) gastric fistula is present (increasing the likelihood of double pigtail stent [DPS] migration).
  
  
  OBJECTIVE
  To compare the results of our previous endoscopic management of large GL or GS associated with GL (using CS only) with those of our new endoscopic treatment (using combined CS and DPS).
  
  
  METHODS
  University hospital, France, public practice.
  
  
  METHODS
  Between January 2009 and June 2015, all patients treated for large GL or GS associated with GL after sleeve gastrectomy (n = 20 patients) were included. Our previous endoscopic management required CS placement (CS group), whereas our new endoscopic treatment required combined CS and DPS placement (CS+DPS group). The primary efficacy endpoint was the treatment duration after CS placement until closure of the GL. The secondary efficacy endpoints were the number of endoscopic procedures, the stent migration rate, and the failure rate.
  
  
  RESULTS
  Nine patients were treated by CS only (CS group), whereas 11 patients were treated by both CS and DPS (CS+DPS group). The median time to GL closure after CS placement was 84 days (33-130) in the CS group and 32 days (26-89) in the CS+DPS group (P≤.05). The median number of endoscopic procedures at the time of CS placement was 2 (1-3) in the CS group and 1 (1-2) in the CS+DPS group (P≤.05). The stent migration rate after CS placement was 33.3% in the CS group and 0% in the CS+DPS group (P = .21), and the failure rate was 11% and 0% (P = .36).
  
  
  CONCLUSIONS
  The combination of CS and DPS constitutes an effective treatment for large GL or GS associated with GL, allowing significantly fewer endoscopic procedures and a shorter treatment duration.
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Department of Gastroentrology, Amiens University Hospital, Amiens, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Hakim
authors.affiliation: Department of Gastroentrology, Amiens University Hospital, Amiens, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Brazier
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
authors.forename: Abdennaceur
authors.initials: A
authors.lastname: Dhahri
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology* / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D013272:Stomach Diseases / Q000209:etiology / Q000601:surgery; D055815:Young Adult
keywords: Covered stent; Double pigtail stent; Gastric leak; Sleeve gastrectomy