Safety and Efficacy of Endoscopically Secured Fully Covered Self-Expandable Metallic Stents (FCSEMS) for Post-Bariatric Complex Stenosis
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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.
To assess the technical feasibility, clinical efficacy, and safety of endoscopically secured FCSEMS in the stomach for > 30 days.
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.
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.
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.
KeywordsFully covered self-expandable metallic stents Endoscopic suturing Roux-en-Y gastric bypass Laparoscopic sleeve gastrectomy Sleeve stenosis
Compliance with Ethical Standards
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.