title: Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections.
abstract: Background and study aimsStaple-line leaks occur in 1 % - 7 % of patients who undergo sleeve gastrectomy, and can be challenging to treat. The success of endoscopic approaches decreases as leaks develop into chronic sinus tracts. Endoscopic septotomy has been used to facilitate healing of refractory leaks by incision and enlargement of the tract to allow direct communication with the gastric lumen and internal drainage.Patients and methodsWe reviewed the technique and outcomes among patients who underwent endoscopic septotomy at two centers for the management of sleeve gastrectomy-associated gastric fistulas and perigastric collections refractory to occlusive endoscopic therapies.ResultsNine patients underwent endoscopic septotomy at a mean of 8.6 weeks after leak diagnosis, following failure of percutaneous and conventional endoscopic modalities. Perigastric collections ranged from 3 cm to 10 cm in size. The mean procedure time for endoscopic septotomy was 87.2 minutes. Multiple endoscopic septotomy procedures (mean 2.3, range 1 - 4) were required to achieve radiological resolution. The mean follow-up period was 21.2 weeks, and all nine patients achieved symptom resolution without the need for surgery. Bleeding at the time of endoscopic septotomy occurred in three patients, and was managed with endoscopic clips and did not require transfusion. No other adverse events or delayed complications were recorded.ConclusionsEndoscopic septotomy appears to be a safe and effective technique for the management of sleeve gastrectomy-associated fistulae and collections, including those refractory to other endoscopic and percutaneous methods.
authors.affiliation: Columbia University, New York, New York, United States.
authors.forename: Srihari
authors.initials: S
authors.lastname: Mahadev
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, United States.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Universidad Federal de Pernambuco, Cidade Universitaria, Recife, Brazil.
authors.forename: Josemberg M
authors.initials: JM
authors.lastname: Campos
authors.affiliation: Gastro Obeso Center, São Paolo, Brazil.
authors.forename: Manoel
authors.initials: M
authors.lastname: Galvao Neto
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, United States.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, United States.
authors.forename: Yamile Haito
authors.initials: YH
authors.lastname: Chavez
authors.affiliation: Columbia University, New York, New York, United States.
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
authors.affiliation: Columbia University, New York, New York, United States.
authors.forename: Tamas A
authors.initials: TA
authors.lastname: Gonda
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult