Abstract
Background
Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient.
Methods
A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb.
Results
Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total clousure of the fistula was reported 30 days afterward.
Conclusions
Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.
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References
Hahler B, Schassberger D, Novakovic R, Lang S (2009) Managing complex, high-output, enterocutaneous fistulas: a case study. Ostomy Wound Manage 55:30–42
Martin-Malagon A, Arteaga-Gonzalez I, Rodriguez-Ballester L, Diaz-Romero F (2010) Gastroesophageal junction leak with serious sepsis after gastric bypass: successful treatment with endoscopy-assisted intraluminal esophageal drainage and self-expandable covered metal stent. Obes Surg 20:240–243
Thaler K (2009) Treatment of leaks and other bariatric complications with endoluminal stents. J Gastrointest Surg 13:1567–1569
Yurcisin BM, DeMaria EJ (2009) Management of leak in the bariatric gastric bypass patient: reoperate, drain, and feed distally. J Gastrointest Surg 13:1564–1566
Edwards CA, Bui TP, Astudillo JA, de la Torre RA, Miedema BW, Ramaswamy A, Fearing NM, Ramshaw BJ, Thaler K, Scott JS (2008) Management of anastomotic leaks after Roux-en-Y bypass using self-expanding polyester stents. Surg Obes Relat Dis 4:594–599
Campos JM, Moura EGH (2008) Fïstula gastrojejunal in endoscopia em cirurgia da obesidade, vol 1, 1st edn. Livraria Santos Editora Ltda, São Paulo-SP, p 435
Flegal KM (2010) Prevalence and trends in obesity among U.S. adults, 1999–2008. J Am Med Assoc 303:235–241
Finkelstein EA et al (2009) Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff 29:w822–w831
Sturm R (2007) Increases in morbid obesity in the USA: 2000–2005. Public Health 121:492–496
Fernandez AZ Jr, DeMaria EJ, Tichansky DS, Kellum JM, Wolfe LG, Meador J, Sugerman HJ (2004) Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 18:193–197 Epub 29 December 2003
Samuel I, Mason EE, Renquist KE, Huang YH, Zimmerman MB, Jamal M (2006) Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry. Am J Surg 192:657–662
Mejía AF, Bolaños E, Chaux CF, Unigarro I (2007) Endoscopic treatment of gastrocutaneous fistula following gastric bypass for obesity. Obes Surg 17:544–546
Ballesta C, Berindoague R, Cabrera M, Palau M, Gonzales M (2008) Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass. Obes Surg 18:623–630 Epub 8 April 2008
Samuel I, Mason EE, Renquist KE, Huang YH, Zimmerman MB, Jamal M (2006) Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry. Am J Surg 192:657–662
Bège T, Emungania O, Vitton V, Ah-Soune P, Nocca D, Noël P, Bradjanian S, Berdah SV, Brunet C, Grimaud JC, Barthet M (2011) An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc 73:238–244
Campos JM, Moura EGH (2008) Tratamento endoscópico de fístula com prótese auto-expansível in endoscopia em cirurgia da obesidade. Vol 1, 1st edn. Livraria Santos Editora Ltda, São Paulo-SP, p 435
Disclosures
Eduardo G. H. de Moura, Manoel P. Galvão-Neto, Almino C. Ramos, Eduardo T. H. de Moura, Thales D. Galvão, Diogo T. H. de Moura, and Flávio C. Ferreira have no conflicts of interest or financial ties to disclose.
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de Moura, E.G.H., Galvão-Neto, M.P., Ramos, A.C. et al. Extreme bariatric endoscopy: stenting to reconnect the pouch to the gastrojejunostomy after a Roux-en-Y gastric bypass. Surg Endosc 26, 1481–1484 (2012). https://doi.org/10.1007/s00464-011-2060-z
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DOI: https://doi.org/10.1007/s00464-011-2060-z