Abstract
Gastrointestinal leaks are severe complications after bariatric surgery, mainly related to postoperative anastomotic defects with substantial morbidity and mortality. Surgical interventions can be complicated with high morbidity and mortality. Surgical drainage can be indicated when there is peritonitis or perigastric abscess. Conservative management can be an option in stable cases with functioning and correctly located drain. Endoscopy is becoming the first line in treating fistulas due to the endoscopic arsenal for closing and covering the leaks and draining collections; this arsenal includes clips and self-expanding metallic prostheses, tissue sealants, in addition to pigtail and negative pressure therapy. Treatment requires an individualized and multidisciplinary approach. Patient clinical stability, defect chronicity, defect characteristics, and resource availability are essential aspects to consider before the treatment. Endoscopy is a tool that allows direct analysis of the leak orifice and visualization of complications such as strictures. This treatment can be individualized, always considering the endoscopist experience, hospital conditions, and available accessories.
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De Moura DTH, Baptista A, Jirapinyo P, De Moura EGH, Thompson C. Role of cardiac septal occluders in the treatment of gastrointestinal fistulas: a systematic review. Clin Endosc. 2020;53(1):37–48.
Cereatti F, Grassia R, Drago A, Conti CB, Donatelli G. Endoscopic management of gastrointestinal leaks and fistulae: what option do we have? World J Gastroenterol. 2020;26(29):4198–217.
Piyachaturawat P, Mekaroonkamol P, Rerknimitr R. Use of the over the scope clip to close perforations and fistulas. Gastrointest Endosc Clin N Am. 2020;30(1):25–39.
Hwang JJ, Jeong YS, Park YS, Yoon H, Shin CM, Kim N, et al. Comparison of endoscopic vacuum therapy and endoscopic stent implantation with self-expandable metal stent in treating postsurgical gastroesophageal leakage. Medicine. 2016;95(16):e3416.
Neto MG, Silva LB, de Quadros LG, Campos JM. Endoscopic interventions for complications in bariatric surgery. In: Camacho D, Zundel N (organizadores) Complications in bariatric surgery [Internet]. Cham: Springer; 2018 [citado 7 de janeiro de 2021]. p. 179–91. Disponível em: http://link.springer.com/10.1007/978-3-319-75841-1_14.
Neto MG, Zundel N. Comprehensive endoluminal treatment of sleeve gastrectomy complications. In: Chand B (organizador). Endoscopy in obesity management [Internet]. Cham: Springer; 2018 [citado 11 de janeiro de 2021]. p. 143–9. Disponível em: http://link.springer.com/10.1007/978-3-319-63528-6_13.
Kwon SH, Oh JH, Kim HJ, Park SJ, Park HC. Interventional management of gastrointestinal fistulas. Korean J Radiol. 2008;9(6):541.
Zundel N, Sahdala HNP, Neto MG. Endoscopic treatment of gastrointestinal fistulas. In: Kroh M, Reavis KM (organizadores) The SAGES manual operating through the endoscope [Internet]. Cham: Springer International Publishing; 2016 [citado 12 de janeiro de 2021]. p. 151–66. Disponível em: http://link.springer.com/10.1007/978-3-319-24145-6_9.
Baretta G, Campos J, Correia S, Alhinho H, Marchesini JB, Lima JH, et al. Bariatric postoperative fistula: a life-saving endoscopic procedure. Surg Endosc. 2015;29(7):1714–20.
Shoar S, Poliakin L, Khorgami Z, Rubenstein R, El-Matbouly M, Levin JL, et al. Efficacy and safety of the over-the-scope clip (OTSC) system in the management of leak and fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2017;27(9):2410–8.
Krishnan V, Hutchings K, Godwin A, Wong JT, Teixeira J. Long-term outcomes following endoscopic stenting in the management of leaks after foregut and bariatric surgery. Surg Endosc. 2019;33(8):2691–5.
Eisendrath P, Deviere J. Major complications of bariatric surgery: endoscopy as first-line treatment. Nat Rev Gastroenterol Hepatol. 2015;12(12):701–10.
Moon RC, Teixeira AF, Bezerra L, Alhinho HCAW, Campos J, de Quadros LG, et al. Management of bariatric complications using endoscopic stents: a multi-center study. Obes Surg. 2018;28(12):4034–8.
Hany M, Ibrahim M, Zidan A, Samir M, Elsherif A, Selema M, et al. Role of primary use of mega stents alone and combined with other endoscopic procedures for early leak and stenosis after bariatric surgery, single-institution experience. Obes Surg [Internet]. 2021 [citado 13 de janeiro de 2021]; Disponível em: http://link.springer.com/10.1007/s11695-020-05211-x.
Bhurwal A. Gastrointestinal fistula endoscopic closure techniques. AOG [Internet]. 2020 [citado 13 de janeiro de 2021]; Disponível em: http://www.annalsgastro.gr/files/journals/1/earlyview/2020/ev-10-2020-08-AG_5267-0543.pdf
Callahan ZM, Su B, Kuchta K, Conaty E, Novak S, Linn J, et al. Endoscopic suturing results in high technical and clinical success rates for a variety of gastrointestinal pathologies. J Gastrointest Surg. 2020;24(2):278–87.
Min YW, Kim T, Lee H, Min B-H, Kim HK, Choi YS, et al. Endoscopic vacuum therapy for postoperative esophageal leak. BMC Surg. 2019;19(1):37.
Loske G. Endoscopic negative pressure therapy of the upper gastrointestinal tract. Chirurg. 2019;90(S1):1–6.
Leeds SG, Burdick JS. Management of gastric leaks after sleeve gastrectomy with endoluminal vacuum (E-Vac) therapy. Surg Obes Relat Dis. 2016;12(7):1278–85.
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Zundel, N., Neto, M.G., de Quadros, L.G., Sadhala, N.P., Azor, F.O. (2023). Endoscopic Treatment of Gastrointestinal Leaks. In: Kroh, M., Docimo Jr., S., El Djouzi, S., Shada, A., Reavis, K.M. (eds) The SAGES Manual Operating Through the Endoscope. Springer, Cham. https://doi.org/10.1007/978-3-031-21044-0_10
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