Effectiveness of Endoscopic Management Using Self-Expandable Metal Stents in a Large Cohort of Patients with Post-bariatric Leaks

Abstract

Background: Endoscopic management of post-bariatric surgery leaks using self-expandable metal stents (SEMSs) is an alternative to revisional surgery. We evaluated the effectiveness of a standardized protocol for management of post-bariatric surgery leaks in a large cohort of patients. Methods: Data from patients with anastomotic leaks after bariatric surgery endoscopically treated with partially covered SEMS in our institution between January 2006 and December 2012 were retrospectively reviewed. Patients were divided into four categories: (1) healing of fistula after only one SEMS, (2) healing of fistula after multiple SEMSs and/or additional therapy, (3) healing of fistula after salvage endoscopic procedure despite SEMS failure, and (4) SEMS and endoscopic failure for fistula healing. Results: Ninety-one patients (median age 42 years; 33 males) were considered suitable for inclusion. Our standardized stenting policy was successful in 74 patients (81 %). Among the 17 patients with SEMS failure, 6 patients were ultimately healed by internal drainage of the leakage (7 %). Endoscopic treatment failed in 11 patients (12 %). In univariate analysis, male gender (p = 0.024), higher prebariatric surgery BMI (p = 0.025), and shorter delay between surgery and SEMS placement (p = 0.011) were more frequently observed in the one-step treatment group (group 1) as compared to the other groups. In multivariate analysis, gender (p = 0.035) and delay between surgery and SEMS placement (p = 0.042) were independent predictive factors of endoscopic success. Conclusions: Endoscopic management using SEMS for anastomotic leaks after bariatric surgery is effective and may avoid risky surgical reintervention in 81 % of patients. Early stenting was a major significant factor associated with increased success.