Andrea Spota1,2, Fabrizio Cereatti1,3, Stefano Granieri4, Giulio Antonelli3, Jean-Loup Dumont1, Ibrahim Dagher5, Renaud Chiche6, Jean-Marc Catheline7, Guillaume Pourcher8, Lionel Rebibo9, Daniela Calabrese9, Simon Msika9, Hadrien Tranchart5, Panagiotis Lainas5, David Danan1, Thierry Tuszynski1, Filippo Pacini10, Roberto Arienzo10, Nelson Trelles11, Antoine Soprani6, Andrea Lazzati12, Adriana Torcivia13, Laurent Genser13, Serge Derhy14, Maurizio Fazi1, Jean-Luc Bouillot15, Jean-Pierre Marmuse16, Jean-Marc Chevallier10, Gianfranco Donatelli17. 1. Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. 2. Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milan, Italy. 3. Ospedale dei Castelli, ASL Roma 6, Via Nettunense km 115, 00040 Ariccia, Roma, Italy. 4. General Surgery Unit, ASST-Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy. 5. Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France. 6. Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France. 7. Department of Digestive Surgery, Centre Hospitalier de Saint - Denis, Saint - Denis, France. 8. Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France. 9. Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat - Claude-Bernard, Paris, France. 10. Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France. 11. Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France. 12. Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France. 13. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 boulevard de l'Hôpital, 75013, Paris, France. 14. Unité de Radiologie Interventionnelle, Hôpital Privé des Peupliers, Paris, France. 15. Service de Chirurgie Digestive et Obésité, Hôpital Paris Saint-Joseph, Paris, France. 16. Service de chirurgie digestive et obésité, Clinique Bizet, Paris, France. 17. Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. donatelligianfranco@gmail.com.
Abstract
BACKGROUND AND AIMS: Endoscopy is effective in management of bariatric surgery (BS) adverse events (AEs) but a comprehensive evaluation of long-term results is lacking. Our aim is to assess the effectiveness of a standardized algorithm for the treatment of BS-AE. PATIENTS AND METHODS: We retrospectively analyzed 1020 consecutive patients treated in our center from 2012 to 2020, collecting data on demographics, type of BS, complications, and endoscopic treatment. Clinical success (CS) was evaluated considering referral delay, healing time, surgery, and complications type. Logistic regression was performed to identify variables of CS. RESULTS: In the study period, we treated 339 fistulae (33.2%), 324 leaks (31.8%), 198 post-sleeve gastrectomy twist/stenosis (19.4%), 95 post-RYGB stenosis (9.3 %), 37 collections (3.6%), 15 LAGB migrations (1.5%), 7 weight regains (0.7%), and 2 hemorrhages (0.2%). Main endoscopic treatments were as follows: pigtail-stent positioning under endoscopic view for both leaks (CS 86.1%) and fistulas (CS 77.2%), or under EUS-guidance for collections (CS 88.2%); dilations and/or stent positioning for sleeve twist/stenosis (CS 80.6%) and bypass stenosis (CS 81.5%). After a median (IQR) follow-up of 18.5 months (4.29-38.68), complications rate was 1.9%. We found a 1% increased risk of redo-surgery every 10 days of delay to the first endoscopic treatment. Endoscopically treated patients had a more frequent regular diet compared to re-operated patients. CONCLUSIONS: Endoscopic treatment of BS-AEs following a standardized algorithm is safe and effective. Early endoscopic treatment is associated with an increased CS rate.
BACKGROUND AND AIMS: Endoscopy is effective in management of bariatric surgery (BS) adverse events (AEs) but a comprehensive evaluation of long-term results is lacking. Our aim is to assess the effectiveness of a standardized algorithm for the treatment of BS-AE. PATIENTS AND METHODS: We retrospectively analyzed 1020 consecutive patients treated in our center from 2012 to 2020, collecting data on demographics, type of BS, complications, and endoscopic treatment. Clinical success (CS) was evaluated considering referral delay, healing time, surgery, and complications type. Logistic regression was performed to identify variables of CS. RESULTS: In the study period, we treated 339 fistulae (33.2%), 324 leaks (31.8%), 198 post-sleeve gastrectomy twist/stenosis (19.4%), 95 post-RYGB stenosis (9.3 %), 37 collections (3.6%), 15 LAGB migrations (1.5%), 7 weight regains (0.7%), and 2 hemorrhages (0.2%). Main endoscopic treatments were as follows: pigtail-stent positioning under endoscopic view for both leaks (CS 86.1%) and fistulas (CS 77.2%), or under EUS-guidance for collections (CS 88.2%); dilations and/or stent positioning for sleeve twist/stenosis (CS 80.6%) and bypass stenosis (CS 81.5%). After a median (IQR) follow-up of 18.5 months (4.29-38.68), complications rate was 1.9%. We found a 1% increased risk of redo-surgery every 10 days of delay to the first endoscopic treatment. Endoscopically treated patients had a more frequent regular diet compared to re-operated patients. CONCLUSIONS: Endoscopic treatment of BS-AEs following a standardized algorithm is safe and effective. Early endoscopic treatment is associated with an increased CS rate.
Authors: Shounak Majumder; Navtej S Buttar; Christopher Gostout; Michael J Levy; John Martin; Bret Petersen; Mark Topazian; Louis M Wong Kee Song; Barham K Abu Dayyeh Journal: Endosc Int Open Date: 2015-12-15