Diogo Turiani Hourneaux de Moura1, Eduardo Guimarães Hourneaux de Moura2, Manoel Galvão Neto3, Pichamol Jirapinyo4, Newton Teixeira5, Ivan Orso6, Luiz Gustavo Quadros7, Artagnan Amorim8, Filipe Medeiros9, Durval Rosa Neto10, João de Siqueira Neto11, Alvaro Albano12, Luiz Henrique de Sousa13, Delano Almeida14, Igor Antunes Marchetti15, Flávio Ivano16, João Henrique Felicio de Lima17, Marcelo Falcão18, Christopher C Thompson19. 1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 2. Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 3. Endovitta Institute, São Paulo, Brazil; Florida International University, Miami, Florida. 4. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 5. Newton Teixeira Gastroenterologia, Rio de Janeiro, Brazil. 6. Gastroclínica Cascavel, Cascavél, Brazil. 7. Kaiser Clínica, São José do Rio Preto, Brazil. 8. Hospital Nove de Julho, São Paulo, Brazil. 9. Hospital Wilson Rosado, Mossoró, Brazil. 10. Hospital Português, Salvador, Brazil. 11. Universidade Federal do Espírito Santo, Vitória, Brazil. 12. Santa Casa de Ilhéus, Ilhéus, Brazil. 13. Clínica Cirúrgica Digestiva e Obesidade, Goiania, Brazil. 14. Instituto do Aparelho Digestivo, Vitória da Conquista, Brazil. 15. Unimed Sorocaba, Sorocaba, Brazil. 16. Hospital Sugisawa, Curitiba, Brazil. 17. Hospital das Clínicas da Universidade Federal do Paraná, Curutiba, Brazil. 18. Hospital Santo Amaro, Salvador, Brazil; Hospital Aliança, Salvador, Brazil. 19. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: cthompson@hms.harvard.edu.
Abstract
BACKGROUND: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SETTING: Multicenter retrospective study. METHODS: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. RESULTS: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. CONCLUSIONS: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.
BACKGROUND: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SETTING: Multicenter retrospective study. METHODS: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. RESULTS: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. CONCLUSIONS: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.
Authors: Franck Billmann; Aylin Pfeiffer; Peter Sauer; Adrian Billeter; Christian Rupp; Ronald Koschny; Felix Nickel; Moritz von Frankenberg; Beat Peter Müller-Stich; Anja Schaible Journal: Obes Surg Date: 2021-11-03 Impact factor: 4.129
Authors: Diogo Turiani Hourneaux de Moura; Bruno Salomão Hirsch; Epifânio Silvino Do Monte Junior; Thomas R McCarty; Flaubert Sena de Medeiros; Christopher C Thompson; Eduardo Guimarães Hourneaux de Moura Journal: VideoGIE Date: 2021-09-04
Authors: Diogo Turiani Hourneaux de Moura; Anna Carolina Batista Dantas; Igor Braga Ribeiro; Thomas R McCarty; Flávio Roberto Takeda; Marco Aurelio Santo; Sergio Carlos Nahas; Eduardo Guimarães Hourneaux de Moura Journal: World J Gastrointest Surg Date: 2022-02-27
Authors: Hytham K S Hamid; Sameh H Emile; Alan A Saber; Mürşit Dincer; Diogo T H de Moura; Lennard P L Gilissen; Majid A Almadi; Mauro Montuori; Michel Vix; Luis G S Perisse; Nicolás Quezada; Fabio Garofalo; Radu Pescarus Journal: Surg Endosc Date: 2020-11-06 Impact factor: 4.584