BACKGROUND: Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results. METHODS: We performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration, and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality. RESULTS: A meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89% (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65% (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54% (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's κ value of 1.0. No deaths were caused directly by complications with the stent placement. CONCLUSIONS: Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.
BACKGROUND: Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results. METHODS: We performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration, and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality. RESULTS: A meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89% (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65% (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54% (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's κ value of 1.0. No deaths were caused directly by complications with the stent placement. CONCLUSIONS: Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.
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Authors: Daniel Gero; Dimitri A Raptis; Wouter Vleeschouwers; Sophie L van Veldhuisen; Andres San Martin; Yao Xiao; Manoela Galvao; Marcoandrea Giorgi; Marine Benois; Felipe Espinoza; Marianne Hollyman; Aaron Lloyd; Hanna Hosa; Henner Schmidt; José Luis Garcia-Galocha; Simon van de Vrande; Sonja Chiappetta; Emanuele Lo Menzo; Cristina Mamédio Aboud; Sandra Gagliardo Lüthy; Philippa Orchard; Steffi Rothe; Gerhard Prager; Dimitri J Pournaras; Ricardo Cohen; Raul Rosenthal; Rudolf Weiner; Jacques Himpens; Antonio Torres; Kelvin Higa; Richard Welbourn; Marcos Berry; Camilo Boza; Antonio Iannelli; Sivamainthan Vithiananthan; Almino Ramos; Torsten Olbers; Matias Sepúlveda; Eric J Hazebroek; Bruno Dillemans; Roxane D Staiger; Milo A Puhan; Ralph Peterli; Marco Bueter Journal: Ann Surg Date: 2019-11 Impact factor: 12.969
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