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Article Dans Une Revue Obesity Surgery Année : 2021

Endoscopic Management of Bariatric Surgery Complications According to a Standardized Algorithm

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Andrea Spota
  • Fonction : Auteur
Fabrizio Cereatti
  • Fonction : Auteur
Stefano Granieri
  • Fonction : Auteur
Giulio Antonelli
  • Fonction : Auteur
Jean-Loup Dumont
  • Fonction : Auteur
Renaud Chiche
  • Fonction : Auteur
David Danan
  • Fonction : Auteur
  • PersonId : 773892
  • IdRef : 19495191X
Thierry Tuszynski
  • Fonction : Auteur
Filippo Pacini
  • Fonction : Auteur
Roberto Arienzo
  • Fonction : Auteur
Nelson Trelles
  • Fonction : Auteur
Andrea Lazzati
Serge Derhy
  • Fonction : Auteur
Maurizio Fazi
  • Fonction : Auteur
Gianfranco Donatelli
  • Fonction : Auteur

Résumé

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.
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Dates et versions

hal-03597306 , version 1 (04-03-2022)

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Citer

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⟩
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