Giuseppe Galloro1, Luca Magno2, Mario Musella3, Raffaele Manta4, Angelo Zullo5, Pietro Forestieri6. 1. Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, Federico II University, Naples, Italy. Electronic address: giuseppe.galloro@unina.it. 2. Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, Federico II University, Naples, Italy. 3. Department of Advanced Bio-Medical Sciences, General Surgery Unit, Federico II University, Naples, Italy. 4. Gastroenterology and Digestive Endoscopy Unit, Nuovo S. Agostino Estense Hospital, Modena, Italy. 5. Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. 6. Department of Clinical Medicine and Surgery, General and Bariatric Surgery Unit; Federico II University, Naples, Italy.
Abstract
BACKGROUND: Staple-line leak is the most serious complication of laparoscopic sleeve gastrectomy (LSG) occurring in .5-7% of cases. Patients with this complication are often managed with an esophageal covered, self-expandable metal stent positioned at endoscopy. Unfortunately, migration of these stents has been reported in 30-50% of cases. A novel fully-covered, self-expanding metal stent (Megastent), specifically designed for post-LSG leaks is now available. The objective of this study was to describe the first case series of patients with a staple-line leak after LSG who were endoscopically managed with such a novel stent. METHODS: Four patients who developed a staple-line leak after LSG were treated by positioning a Megastent at endoscopy. The stents were removed after 8 weeks. RESULTS: A complete leak repair was achieved in all patients. No stent migration occurred. Prokinetic therapy was needed to treat vomiting episodes during stent presence. At endoscopic evaluation after stent removal, a decubitus lesion at the distal part of the duodenal bulb was observed. CONCLUSION: These preliminary results would suggest the use of the Megastent as an option for stenting of a staple-line leak after LSG. Further studies are still necessary.
BACKGROUND: Staple-line leak is the most serious complication of laparoscopic sleeve gastrectomy (LSG) occurring in .5-7% of cases. Patients with this complication are often managed with an esophageal covered, self-expandable metal stent positioned at endoscopy. Unfortunately, migration of these stents has been reported in 30-50% of cases. A novel fully-covered, self-expanding metal stent (Megastent), specifically designed for post-LSG leaks is now available. The objective of this study was to describe the first case series of patients with a staple-line leak after LSG who were endoscopically managed with such a novel stent. METHODS: Four patients who developed a staple-line leak after LSG were treated by positioning a Megastent at endoscopy. The stents were removed after 8 weeks. RESULTS: A complete leak repair was achieved in all patients. No stent migration occurred. Prokinetic therapy was needed to treat vomiting episodes during stent presence. At endoscopic evaluation after stent removal, a decubitus lesion at the distal part of the duodenal bulb was observed. CONCLUSION: These preliminary results would suggest the use of the Megastent as an option for stenting of a staple-line leak after LSG. Further studies are still necessary.
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