Catherine Beck, MD, Dean Mikami, MD
The Ohio State University Medical Center
Introduction: Complications of gastric restrictive procedures, including gastric leaks, fistulas and stoma enlargement, impart significant morbidity and mortality to the patient. The treatment of such complications often involves further surgical procedures that result in significant cost, pain and resource utilization. This can be reduced when they are treated by less invasive means. We therefore performed a retrospective review of the treatment of such complications using the OverStitch ™ device (Apollo Endosurgery, Austin, TX) at our institution to evaluate the effectiveness of this novel, endoscopic surgical technique.
Methods: This study was completed following approval by the Institutional Review Board at The Ohio State University. Eight patients who had undergone either Roux-en-Y gastric bypass or sleeve gastrectomy were evaluated following treatment of complications using the OverStitch™ device. Each patient was evaluated by index operation performed, complication, symptoms, and resolution of complication. Complications included: gastric leak, gastro-gastric fistula, and stoma enlargement. Upper gastrointestinal imaging (EGI) or esophagoduodenoscopy (EGD) was used to document the presence of each complication. Resolution was then demonstrated by resolution of symptoms, UGI or EGD.
Results: Three patients were treated for gastric leak following sleeve gastrectomy. All three patients were treated using both the OverStitch™ device and endoscopic temporary stent placement. Two patients had complete resolution of leaks. One patient showed continued leak following temporary stent removal that resolved after injection of Tiseel, clip application and entamolin injection. Three patients were treated for gastro-gastric fistula. No further fistula was seen in two patients, while one demonstrated a continued fistula on UGI. The OverStitch™ device was used to treat two patients with enlarged stomas after Roux-en-Y gastric bypass and resultant weight gain. One patient demonstrated weight loss after stoma size reduction, while one patient did not.
Conclusions: Early results with the OverStitch™ device at out institution show promising results in the treatment of leaks, weight gain and gastro-gastric fistulas of both sleeve gastrectomies and Roux-en-Y gastric bypass. While results at this time are too early to perform a statistical analysis of the device’s multiple applications, this novel technique shows potential in the treatment of complications that cause significant morbidity and mortality in a high-risk surgical population. Continued use of this device will allow further investigation into its potential application as well as its ability to provide statistically significant results in the treatment of multiple complications of gastric restrictive procedures.
Session: Poster Presentation
Program Number: P672