Varun Krishnan, MD, Kevin Hutchings, Jonathan Wong, MD, Julio Teixeira, MD. Lenox Hill Hospital
Endoscopic stenting has been shown to be effective in treating leaks after bariatric surgery. However, concerns remain regarding the long term efficacy and secondary effects. Thus the objective of this study was to evaluate long-term outcomes after endoscopic therapy for leaks after bariatric surgery with respect to percent excess body weight loss (%EBWL), long term PPI use, and symptoms of reflux.
A retrospective review was conducted including patients from 2005-2017 who had undergone placement of stents after various bariatric procedures. Stents were placed endoscopically and, after 2012, secured with a figure-of-eight overstitch. Demographics, weight loss data, revisional surgery, chronic PPI use, and chronic symptoms of reflux data were obtained and analyzed.
37 patients from 2005-2017 required endoscopic stenting for leaks. 43.24% patients underwent sleeve gastrectomy, 40.54% underwent gastric bypass, 5.40% patients underwent duodenal switch, and 10.81% underwent miscellaneous foregut procedures. The overall success rate was 91.89%. Robust follow up data was available for 21 of these patients. Of these patients, 66.67% patients underwent sleeve gastrectomy, 23.80% underwent revision of roux-en-y gastric bypass (RYGB), and 9.52% patients underwent duodenal switch (DS). There was 1 long term treatment failure requiring revision surgery and 1 short term treatment failure, requiring re-stenting. Overall, the %EBWL was 57.21% over an average of 21 months. Total follow up time ranged from 1 month to 71 months. 58.82% of patients used PPI chronically, however 41.17% noted actual symptoms of reflux. 14.28% (3 of 21) patients ultimately underwent revisional surgery.
|Procedure||%EBWL||#Months Follow-up||Chronic PPI Use||Symptoms of reflux|
|Sleeve Gastrectomy (N=14)||63.94%||24.43||58.33% (7/12)||33.33% (4/12)|
|Revision RYGB (N=5)||45.22%||14.60||75% (3/4)||75% (3/4)|
|DS (N=2)||40.07%||20.00||0% (0/1)||0% (0/1)|
|Total (N=21)||57.21%||21.00||58.82% (10/17)||41.17% (7/17)|
Endoscopic stenting is an effective treatment for leaks after bariatric surgery. Despite undergoing treatment with stenting, these patients had successful weight loss with relatively low rates of chronic PPI use and reflux symptoms.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87849
Program Number: S026
Presentation Session: Bariatrics 1 Session
Presentation Type: Podium