Long-term Outcome After Endoscopic Stent Therapy for Complications After Bariatric Surgery

OBJECTIVE: The purpose was to analyze long term outcomes of the largest series to date treating staple line complications after bariatric surgery with endoscopic covered stents.

METHODS: All patients treated with stents for staple line complications after bariatric surgery underwent retrospective evaluation and a telephone questionnaire to assess their symptom scores. Acute postoperative leaks, chronic gastrocutaneous fistulas, and anastomotic strictures refractory to endoscopic dilation after both gastric bypass and sleeve gastrectomy were included.

RESULTS: Twenty six patients (14-leaks, 3-fistulas, 6-strictures and 3-combination of the above) were treated with a total of 55 endoscopic stents (27 polyester, 28 nitinol). Mean age was 47 yrs (19 females). Mean follow up was 15 months. There was no mortality. Mean OR time was 58 minutes. Symptomatic improvement occurred in 92% of patients. Oral feeding was started in 79% of patients within 24 hours of stenting. Healing of leak, fistula or stricture after stent treatment occurred in 22 of 26 patients (85%) at a mean of 46, 56, and 9 days for leak, fistula, and stricture, respectively. Four patients (15%), 1 with leak, 1 with fistula, and 2 with stricture had unsuccessful stent treatment, 2 required surgical intervention (1 leak, 1 fistula). At follow-up, 24/26 (92%) patients were tolerating a regular diet with 8 % recurrence rate (1stricture, 1 fistula).
Stent migration was the most common complication (40%) including laparoscopic extraction for migration (2 pts, 8%) and for incorporation (1 pt, 4%). Other stent related complications were stent fracture (1 pt, 4%), stent kinking (1 pt, 4%) and enterotomy from stent removal (1 pt, 4%). Migration rate was 48% for the polyester and 32% for the nitinol stents respectively (p

Session: Podium Presentation

Program Number: S070

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