Article

Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis.

Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Gastrointestinal endoscopy (impact factor: 6.71). 10/2011; 75(2):287-93. DOI:10.1016/j.gie.2011.09.010 pp.287-93
Source: PubMed

ABSTRACT Bariatric surgery leaks can result in significant morbidity and mortality. Endoscopic placement of self-expandable stents (SESs) is emerging as a less-invasive alternative to surgery for the treatment of leaks.
To evaluate the success of SESs in the treatment of bariatric surgery leaks.
Studies using SESs in the management of bariatric surgery leaks were selected. Success of SES treatment was defined as radiographic evidence of leak closure after stent removal. Articles were searched in MEDLINE, PubMed, Ovid, and Cochrane Register of Controlled Trials. Pooled proportions were calculated by using fixed- and random-effects models. Publication bias was calculated by using the Begg-Mazumdar and Harbord bias estimators.
A total of 189 relevant articles were reviewed of which 7 studies (67 patients with leaks) met inclusion criteria. The pooled proportion of successful leak closures by using SESs was 87.77% (95% CI, 79.39%-94.19%). The pooled proportion of successful endoscopic stent removal was 91.57% (95% CI, 84.22%-96.77%). Stent migration was noted in 16.94% (95% CI, 9.32%-26.27%). Test of heterogeneity gave a P value >.10. There was no publication bias.
Small retrospective studies, different types of stents used.
Endoscopic placement of SESs is a minimally invasive, safe, and effective alternative in the management of leaks after bariatric surgery. The use of SESs can minimize the need for surgical revision and improve patient outcomes.

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    Article: Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital.
    Bart J M Leenders, Arnold Stronkhorst, Frans J Smulders, Grard A Nieuwenhuijzen, Lennard P L Gilissen
    [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND: Anastomotic leakages are severe complications of upper gastrointestinal surgery with serious morbidity and mortality. Until recently, only abscess drainage was possible. Since 2007, removable and repositionable covered metal self-expandable stents (RReCoMSeS) have been used in our hospital to cover leaks. METHODS: Patients with postsurgical gastrointestinal leaks treated with RReCoMSeS between January 2007 and March 2010 were retrospectively evaluated and described. RESULTS: Twenty-six patients were treated with RReCoMSeS (totally covered Choo/Hanaro and partially covered Endoflex stents). Included patients had anastomotic leaks after esophagectomy (15) and bariatric surgery (11). Overall successful sealing of the leak occurred in 81 % (including multiple procedures). In total 33 RReCoMSeS were used (mean 1.3 stents and 1.7 procedures per patient). Twenty-one of 33 RReCoMSeS succeeded in sealing the leak (64 %). Migration occurred in 24 % RReCoMSeS, and 9 % disintegrated. One stent (3 %) caused a perforation. CONCLUSIONS: RReCoMSeS are a safe alternative for treating postsurgical leaks in the upper gastrointestinal tract. In 81 % of patients and with 64 % of the inserted stents, leaks were sealed successfully, with few complications. Fewer stents per patient were needed thanks to their repositionability. Stent migration is a major problem.
    Surgical Endoscopy 02/2013; · 4.01 Impact Factor
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Keywords

189 relevant articles
 
67 patients
 
7 studies
 
bariatric surgery
 
bariatric surgery leaks
 
Cochrane Register
 
Controlled Trials
 
Endoscopic placement
 
Harbord bias estimators
 
patient outcomes
 
pooled proportion
 
Pooled proportions
 
publication bias
 
radiographic evidence
 
self-expandable stents
 
SES treatment
 
Small retrospective studies
 
stent removal
 
successful endoscopic stent removal
 
successful leak closures
 

Srinivas R Puli