Long-term outcomes following endoscopic stenting in the management of leaks after foregut and bariatric surgery.

ABSTRACT

INTRODUCTION: Endoscopic stenting has been shown to be effective in treating leaks after bariatric surgery. However, concerns remain regarding its long-term efficacy. The purpose of this study was to assess the evolution of endoscopic stenting and its efficacy over time, as well as the impact of stent fixation on migration rates and long-term outcomes. In addition, the effect of stenting on long-term weight loss and chronic reflux was also evaluated. METHODS: A retrospective review was conducted including 37 patients from 2005 to 2017 who had undergone placement of stents after various bariatric procedures. Stents were placed endoscopically and, after 2012, secured with a figure-of-eight overstitch. Demographics, weight loss data, stent migration rates, incidence of revision surgery, chronic PPI use, and chronic symptoms of reflux data were obtained and analyzed. RESULTS: Thirty-seven patients from 2005 to 2017 required endoscopic stenting for leaks. 43.24% patients underwent sleeve gastrectomy, 40.54% gastric bypass, 5.40% patients underwent duodenal switch, and 10.81% underwent miscellaneous foregut procedures. The overall success rate was 94.59% (35 of 37 patients). The incidence of stent migration before 2012 was 41.18% versus 15% after 2012 (p = 0.136271). There were 2 treatment failures, one treated successfully with re-stenting and another other requiring revision surgery. Overall, the percent of excess body weight lost was 57.21% over an average of 21 months. 58.82% of patients used PPI chronically; however 41.17% noted actual symptoms of reflux. 16.22% (6 of 37) patients ultimately underwent revision surgery. CONCLUSION: Endoscopic stenting is a safe and effective treatment for leaks after bariatric surgery. While complications can include stent migration, newer stent technology and endoscopic overstitching techniques show promise in reducing the incidence of stent migration. Despite undergoing treatment with stenting, these patients had successful weight loss with relatively low rates of chronic PPI use and reflux symptoms.