Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients

Gianfranco Donatelli , Andrea Spota , Fabrizio Cereatti , Stefano Granieri , Ibrahim Dagher (1, 2) , Renaud Chiche , Jean-Marc Catheline (3) , Guillaume Pourcher (4) , Lionel Rebibo (5, 6) , Daniela Calabrese (7) , Simon Msika (8, 9) , Carmelisa Dammaro , Hadrien Tranchart (1, 2) , Panagiotis Lainas (1, 2) , Thierry Tuszynski , Filippo Pacini , Roberto Arienzo , Jean-Marc Chevallier (10) , Nelson Trelles , Andrea Lazzati (11) , Luca Paolino (12) , Federica Papini , Adriana Torcivia (13) , Laurent Genser (14, 13) , Kostas Arapis , Antoine Soprani (11) , Bruto Randone , Denis Chosidow , Jean-Luc Bouillot (15) , Jean-Pierre Marmuse (8, 9) , Jean-Loup Dumont

1 UP11 UFR Médecine - Université Paris-Sud - Paris 11 - Faculté de médecine
2 Service de Chirurgie Digestive Minimale Invasive [Clamart]
3 Hôpital Delafontaine
4 Département de Pathologies digestives [Institut Mutualiste Montsouris]
5 Chirurgie digestive [CHU Amiens]
6 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
7 Enterra Research Group
8 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
9 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
10 HEGP - Hôpital Européen Georges Pompidou [APHP]
11 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
12 DMI - Dipartimento di Matematica e Informatica
13 CHU Pitié-Salpêtrière [AP-HP]
14 Nutriomics - Nutrition et obésités: approches systémiques (UMR-S 1269)
15 Centre hospitalier Saint-Joseph [Paris]

Background: Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. Objectives: To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. Setting: Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. Methods: EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. Results: A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). Conclusion: Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Domaines: Sciences du Vivant [q-bio]

Gianfranco Donatelli, Andrea Spota, Fabrizio Cereatti, Stefano Granieri, Ibrahim Dagher, et al.. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surgery for Obesity and Related Diseases, 2021, 17 (8), pp.1432-1439. ⟨10.1016/j.soard.2021.03.013⟩. ⟨hal-03597305⟩