Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm

Andrea Spota , Fabrizio Cereatti , Stefano Granieri , Giulio Antonelli , Jean-Loup Dumont , Ibrahim Dagher (1, 2) , Renaud Chiche , Jean-Marc Catheline (3) , Guillaume Pourcher (4) , Lionel Rebibo (5, 6) , Daniela Calabrese (7) , Simon Msika (8, 9) , Hadrien Tranchart (1, 2) , Panagiotis Lainas (1, 2) , David Danan (10) , Thierry Tuszynski , Filippo Pacini , Roberto Arienzo , Nelson Trelles , Antoine Soprani (11) , Andrea Lazzati (11) , Adriana Torcivia (12) , Laurent Genser (13, 14) , Serge Derhy , Maurizio Fazi , Jean-Luc Bouillot (15) , Jean-Pierre Marmuse (8, 9) , Jean-Marc Chevallier (10) , Gianfranco Donatelli

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 CHU Pitié-Salpêtrière [AP-HP]
13 Nutriomics - Nutrition et obésités: approches systémiques (UMR-S 1269)
14 Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière]
15 Centre hospitalier Saint-Joseph [Paris]

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 tinder 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.

Domaines: Sciences du Vivant [q-bio]

Andrea Spota, Fabrizio Cereatti, Stefano Granieri, Giulio Antonelli, Jean-Loup Dumont, et al.. Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm. Obesity Surgery, 2021, 31 (10), pp.4327-4337. ⟨10.1007/s11695-021-05577-6⟩. ⟨hal-03597306⟩