Ossamu Okazaki

Efficacy and Safety of Stents in the Treatment of Fistula After Bariatric Surgery: a Systematic Review and Meta-analysis

Fistula development is a serious complication after bariatric surgery. We performed a systematic review and meta-analysis to assess the efficacy of fistula closure and complications associated with endoscopic stent treatment of fistulas, developed after bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS). Studies involving patients with fistula after RYGB or GS and those who received stent treatment only were selected. The analyzed outcomes were overall success rate of fistula closure, mean number of stents per patient, mean stent dwelling time, and procedure-associated complications. Current evidence from identified studies demonstrates that, in selected patients, endoscopic stent treatment of fistulas after GS or RYGB can be safe and effective.

Stent migration requiring surgical removal: a serious adverse event after bariatric megastent placement

Leaks are serious complications after sleeve gastrectomy, with an incidence rate up to 7% [1]. Currently, stent placement and other endoscopic techniques are recommended for the treatment of post-bariatric leaks (PBLs) [2]. Bariatric stents are a feasible, effective and lifesaving method [3]. They achieve leak closure rates between 72.8% and 87.8% but are associated with significant migration rates (16.9%–28.2%) [1, 4]. The large bariatric-specific stent (LBSS) has been developed as an important device to fit bariatric anatomy and avoid migration because of its long length with the distal edge being placed in the duodenum [5]. We report the case of 34-year-old woman who underwent sleeve gastrectomy. On the 5th post-operative day (POD), she developed abdominal pain and purulent output from the drain. Computed tomography (CT) scanning showed a leak at the angle of His without any collections. We opted to place an LBSS (24 cm× 28mm; Hanarostent, MITECH) to bypass the whole stomach (▶Fig. 1). The LBSS was removed 4 weeks later (33th POD), but the leak persisted. We then placed two single-pigtail stents (▶Fig. 2) and kept them in place for 10 days, but this was also unsuccessful. On the 43 rd POD, we removed the pigtail stents, performed a septotomy, and placed a second LBSS (▶Fig. 3). After 3 weeks (64th POD), the patient again presented with abdominal pain. On this occasion, esophagogastroduoE-Videos