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Safety and Efficacy of Endoscopically Secured Fully Covered Self-Expandable Metallic Stents (FCSEMS) for Post-Bariatric Complex Stenosis

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Abstract

Background

The use of fully covered self-expandable metallic stents (FCSEMS) has opened the door to treat stenosis in the post-bariatric stomach. We hypothesized that endoscopically securing a FCSEMS would be technically feasible, effective, and safe for > 30-day dwell time.

Objectives

To assess the technical feasibility, clinical efficacy, and safety of endoscopically secured FCSEMS in the stomach for > 30 days.

Methods

A retrospective review (September 2016 to April 2018) of consecutive patients who underwent FCSEMS suturing in the stomach at a single academic institution was reviewed. Technical success, stent dwell time, symptoms, and adverse events were recorded.

Results

Fifteen patients (median age of 49 (31–70)) were included. Stents were inserted for gastrojejunal (GJ) stricture or gastric stenosis in 9/15 and 6/15 of patients, respectively. All procedures were technically successful (100%). Immediate and short-term clinical success (prior to stent removal) was 100% in patients who did not have stent migration. Stent migration was seen in 3 cases (20%) after a median dwell time of 211 days. However, 2/3 (66.6%) had not attended their scheduled removal. Recurrence of symptoms after stent removal was seen in 53.3% of patients with 40% undergoing repeat stenting. Median stent dwell was 117 (30–342) days. Sixty percent and 33% of patients had stent dwell of at least 90 and 180 days, respectively.

Conclusions

A FCSEMS, if secured, may be safe and effective for even > 90-day dwell time in the post-bariatric stomach and may result in long-term clinical success for GJ stricture after stent removal.

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Authors and Affiliations

  1. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Lea Fayad, Cem Simsek, Roberto Oleas, Yervant Ichkhanian, Georges E. Fayad, Saowanee Ngamreungphong, Michael Schweitzer, Andreas Oberbach, Anthony N. Kalloo, Mouen A. Khashab & Vivek Kumbhari

Authors
  1. Lea Fayad
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  2. Cem Simsek
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  3. Roberto Oleas
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  4. Yervant Ichkhanian
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  5. Georges E. Fayad
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  6. Saowanee Ngamreungphong
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  7. Michael Schweitzer
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  8. Andreas Oberbach
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  9. Anthony N. Kalloo
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  10. Mouen A. Khashab
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  11. Vivek Kumbhari
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Corresponding author

Correspondence to Vivek Kumbhari.

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Ethical Approval Statement

For this type of study, formal consent is not required.

Informed Consent Statement

Informed consent does not apply.

Conflict of Interest

Mouen A Khashab is on the medical advisory board for Boston Scientific and Olympus America and is a consultant for Boston Scientific, Olympus America, and Medtronic. Anthony N Kalloo is a founding member, equity holder, and consultant for Apollo Endosurgery. Vivek Kumbhari is a consultant for Medtronic, Reshape Lifesciences, Boston Scientific, and Apollo Endosurgery. He also receives research support from ERBE USA and Apollo Endosurgery. All the other authors have nothing to disclose.

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– Video demonstration of the stent suturing process (MP4 296,017 kb)

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Fayad, L., Simsek, C., Oleas, R. et al. Safety and Efficacy of Endoscopically Secured Fully Covered Self-Expandable Metallic Stents (FCSEMS) for Post-Bariatric Complex Stenosis. OBES SURG 29, 3484–3492 (2019). https://doi.org/10.1007/s11695-019-04021-0

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  • DOI: https://doi.org/10.1007/s11695-019-04021-0

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