BACKGROUND: Gastric leaks represent an important source of morbidity and mortality associated with Roux-en-Y gastric bypass. These leaks, once managed acutely, can become chronic and represent a difficult clinical challenge. Surgical options to address a chronic gastric leak are technically challenging and often unsuccessful. We present a novel peroral endoscopic treatment for patients with chronic gastric leaks after Roux-en-Y gastric bypass. DESIGN: Case series. INTERVENTIONS: Repair of chronic gastric leaks after Roux-en-Y gastric bypass by using a combination of argon plasma coagulation, hemoclips, fibrin glue, Polyflex stent placement, and distal gastrojejunal stenosis dilation. The goal was to achieve durable fistula closure and avoid surgery. MAIN OUTCOME MEASUREMENTS: Durable fistula closure as assessed by an upper-GI series and clinical evaluation. RESULTS: Gastric leak closure was achieved in all 3 patients, with complete resolution of symptoms. Polyflex stent migration into the Roux limb occurred in 1 patient, and this was retrieved endoscopically. There were no other significant complications. CONCLUSIONS: Peroral endoscopic repair of gastric leaks is technically feasible. This procedure may offer a less invasive alternative to traditional surgical revision.
BACKGROUND:Gastric leaks represent an important source of morbidity and mortality associated with Roux-en-Y gastric bypass. These leaks, once managed acutely, can become chronic and represent a difficult clinical challenge. Surgical options to address a chronic gastric leak are technically challenging and often unsuccessful. We present a novel peroral endoscopic treatment for patients with chronic gastric leaks after Roux-en-Y gastric bypass. DESIGN: Case series. INTERVENTIONS: Repair of chronic gastric leaks after Roux-en-Y gastric bypass by using a combination of argon plasma coagulation, hemoclips, fibrin glue, Polyflex stent placement, and distal gastrojejunal stenosis dilation. The goal was to achieve durable fistula closure and avoid surgery. MAIN OUTCOME MEASUREMENTS: Durable fistula closure as assessed by an upper-GI series and clinical evaluation. RESULTS:Gastric leak closure was achieved in all 3 patients, with complete resolution of symptoms. Polyflex stent migration into the Roux limb occurred in 1 patient, and this was retrieved endoscopically. There were no other significant complications. CONCLUSIONS: Peroral endoscopic repair of gastric leaks is technically feasible. This procedure may offer a less invasive alternative to traditional surgical revision.
Authors: Richdeep S Gill; Kevin A Whitlock; Rachid Mohamed; Koroush Sarkhosh; Daniel W Birch; Shahzeer Karmali Journal: J Interv Gastroenterol Date: 2012-01-01
Authors: G Donatelli; J-L Dumont; F Cereatti; S Ferretti; B M Vergeau; T Tuszynski; G Pourcher; H Tranchart; P Mariani; A Meduri; J-M Catheline; I Dagher; F Fiocca; J-P Marmuse; B Meduri Journal: Obes Surg Date: 2015-07 Impact factor: 4.129
Authors: Ramon Vilallonga; José Manuel Fort; Oscar Gonzalez; Juan Antonio Baena; Albert Lecube; Josè Salord; Manel Armengol Carrasco; Josep Ramon Armengol-Miró Journal: Diagn Ther Endosc Date: 2010-06-20