title: Evolution of endoscopic treatment of sleeve gastrectomy leaks: from partially covered to long, fully covered stents.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (SG) has become a widely accepted option in the treatment of morbid obesity. Gastric leaks after SG occur in .9%-2.2% of the patients, mostly at the gastroesophageal junction. The current treatment algorithm includes drainage, antibiotics, nutritional support, and endoluminal control.
  
  
  OBJECTIVE
  Our hypothesis is that long, fully covered stents represent a safe, effective solution for SG leaks.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A retrospective analysis of our prospectively collected bariatric database was performed between June 2014 and May 2016. We included all patients treated for leaks after SG. Endoscopic treatment included partially covered metallic stent (Wallstent, Boston Scientific, Galway, Ireland), fully covered stent (Mega stent, Taewoong Medical Industries, Gyeonggi-do, South Korea), over-the-scope clip (Ovesco Endoscopy, Tubingen, Germany), and internal pigtail drainage.
  
  
  RESULTS
  A total of 872 SGs were performed. Overall, 10 of 872 patients (1.1%) developed a gastric leak. One patient was an outside referral. The 11 patients underwent endoscopic treatment accompanied by either percutaneous or laparoscopic abscess drainage. Endoscopic fistula closure at the gastroesophageal junction was achieved in 10 of 11 cases and the average time for closure was 9.9 (range: 4-24) weeks. One patient developed a second leak in the antrum, treated by subtotal gastrectomy. Overall, treatment with Wallstent failed in 3 of 5 patients, and these patients were eventually successfully treated with a Mega stent. The initial use of long, fully covered stents was successful in 5 of 6 cases.
  
  
  CONCLUSIONS
  Long, fully covered stents appear to be a good alternative to traditional stents either as primary treatment or after failure of other endoscopic treatments.
authors.affiliation: Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
authors.forename: Fabio
authors.initials: F
authors.lastname: Garofalo
authors.affiliation: Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
authors.forename: Maxime
authors.initials: M
authors.lastname: Noreau-Nguyen
authors.affiliation: Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Denis
authors.affiliation: Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
authors.forename: Henri
authors.initials: H
authors.lastname: Atlas
authors.affiliation: Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Garneau
authors.affiliation: Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada. Electronic address: radupes@yahoo.com.
authors.forename: Radu
authors.initials: R
authors.lastname: Pescarus
mesh_terms: D018784:Abdominal Abscess / Q000601:surgery; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000601:surgery; D004322:Drainage / Q000379:methods; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000295:instrumentation* / Q000379:methods; D005773:Gastroscopy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D056888:Patient Positioning; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D017792:Surgical Stapling / Q000379:methods
keywords: Covered stent; Gastric fistula; Mega stent; Sleeve gastrectomy; Wallstent