Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used,Obesity Surgery

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Endoscopic Stent Placement Can Successfully Treat Gastric Leak Following Laparoscopic Sleeve Gastrectomy If and Only If an Esophagoduodenal Megastent Is Used
Obesity Surgery ( IF 2.9 ) Pub Date : 2021-11-03 , DOI: 10.1007/s11695-021-05467-x
Franck Billmann ₁ , Aylin Pfeiffer ₁ , Peter Sauer ₂ , Adrian Billeter ₁ , Christian Rupp ₂ , Ronald Koschny ₂ , Felix Nickel ₁ , Moritz von Frankenberg ₃ , Beat Peter Müller-Stich ₁ , Anja Schaible _{1,

2}

Affiliation

Purpose

Gastric staple line leakage (GL) is a serious complication of laparoscopic sleeve gastrectomy (LSG), with a specific mortality ranging from 0.2 to 3.7%. The current treatment of choice is stent insertion. However, it is unclear whether the type of stent which is inserted affects treatment outcome. Therefore, we aimed not only to determine the effectiveness of stent treatment for GL but also to specifically clarify whether treatment outcome was dependent on the type of stent (small- (SS) or megastent (MS)) which was used.

Patients and Methods

A single-centre retrospective study of 23 consecutive patients was conducted to compare the outcomes of SS (n = 12) and MS (n = 11) for the treatment of GL following LSG. The primary outcome measure was the success rate of stenting, defined as complete healing of the GL without changing the treatment strategy. Treatment change or death were both coded as failure.

Results

The success rate of MS was 91% (10/11) compared to only 50% (6/12) for SS (p = 0.006). An average of 2.3 ± 0.5 and 6.8 ± 3.7 endoscopies were required to achieve healing in the MS and SS groups respectively (p < 0.001). The average time to resumption of oral nutrition was shorter in the MS group (1.4 ± 1.1 days vs. 23.1 ± 33.1 days, p = 0.003).

Conclusions

Stent therapy is only effective and safe for the treatment of GL after LSG if a MS is used. Treatment with a MS may not only increase treatment success rates but may also facilitate earlier resumption of oral nutrition and shorten the duration of hospitalization.

Graphical Abstract

中文翻译：

当且仅当使用食管十二指肠巨型支架时，内镜支架置入才能成功治疗腹腔镜袖状胃切除术后胃漏

目的

胃缝合线渗漏（GL）是腹腔镜袖状胃切除术（LSG）的严重并发症，死亡率为0.2%至3.7%。目前选择的治疗方法是支架置入。然而，尚不清楚插入的支架类型是否会影响治疗结果。因此，我们的目的不仅是确定 GL 支架治疗的有效性，而且还具体阐明治疗结果是否取决于所使用的支架类型（小支架（SS）或巨型支架（MS））。

患者和方法

对 23 名连续患者进行了一项单中心回顾性研究，比较 LSG 后 GL 治疗的 SS (n = 12) 和 MS (n = 11) 的结果。主要结果指标是支架置入术的成功率，定义为在不改变治疗策略的情况下 GL 完全愈合。治疗改变或死亡都被编码为失败。

结果

MS 的成功率为 91% (10/11)，而 SS 的成功率为 50% (6/12) (p = 0.006)。 MS 组和 SS 组平均分别需要 2.3 ± 0.5 次和 6.8 ± 3.7 次内窥镜检查才能实现愈合 (p < 0.001)。 MS 组恢复口服营养的平均时间较短（1.4 ± 1.1 天 vs. 23.1 ± 33.1 天，p = 0.003）。