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Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series

BACKGROUND AND AIMS:  Postoperative leak is one of the most feared complications after bariatric surgery. Endoscopic stenting is used to manage leaks by decreasing the gastrointestinal intraluminal pressure. The main advantage of endoscopic management is providing healing while still allowing for or...

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Autores principales: Al Lehibi, Abed, Al Balkhi, Areej, Al Mtawa, Abdullah, Al Otaibi, Nawaf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2018
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979196/
https://www.ncbi.nlm.nih.gov/pubmed/29868637
http://dx.doi.org/10.1055/a-0600-9562
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author Al Lehibi, Abed
Al Balkhi, Areej
Al Mtawa, Abdullah
Al Otaibi, Nawaf
author_facet Al Lehibi, Abed
Al Balkhi, Areej
Al Mtawa, Abdullah
Al Otaibi, Nawaf
author_sort Al Lehibi, Abed
collection PubMed
description BACKGROUND AND AIMS:  Postoperative leak is one of the most feared complications after bariatric surgery. Endoscopic stenting is used to manage leaks by decreasing the gastrointestinal intraluminal pressure. The main advantage of endoscopic management is providing healing while still allowing for oral nutrition. However, limited literature exists on whether biodegradable stents can be used to control leaks when conventional metallic stents fail. METHODS:  Our series consists of four patients who were found to have a leak as a complication of bariatric surgery. Two patients were initially managed by abdominal/chest drainage, and one required total parenteral nutrition. Conventional endoscopic exclusion techniques with short and long fully covered metallic stents were tried and failed in three of the four patients included in this series. Thus, biodegradable stents were used as a rescue option. RESULTS:  Biodegradable stents provided immediate improvement for all of the patients, and Gastrografin studies were leak-free 2 days after the procedure. All patients were started on oral feeding and discharged home within 5 – 6 days later. Minimum outpatient follow-up of 8 weeks was achieved with no issues. Follow-up endoscopy was performed 2 – 3 months later in three patients and showed completely resorbed stents. The only drawback was the mucosal reaction to the stent causing dysphagia in two patients, who eventually needed esophageal dilatation. CONCLUSION:  Biodegradable stents have the potential to provide a reasonable rescue option to manage post bariatric surgery leaks in patients who fail conventional endoscopic exclusion methods. However, data from larger studies are needed to collect information on which theoretical advantages/disadvantages of degradable biomaterials apply to real practice.
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spelling pubmed-59791962018-06-04 Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series Al Lehibi, Abed Al Balkhi, Areej Al Mtawa, Abdullah Al Otaibi, Nawaf Endosc Int Open BACKGROUND AND AIMS:  Postoperative leak is one of the most feared complications after bariatric surgery. Endoscopic stenting is used to manage leaks by decreasing the gastrointestinal intraluminal pressure. The main advantage of endoscopic management is providing healing while still allowing for oral nutrition. However, limited literature exists on whether biodegradable stents can be used to control leaks when conventional metallic stents fail. METHODS:  Our series consists of four patients who were found to have a leak as a complication of bariatric surgery. Two patients were initially managed by abdominal/chest drainage, and one required total parenteral nutrition. Conventional endoscopic exclusion techniques with short and long fully covered metallic stents were tried and failed in three of the four patients included in this series. Thus, biodegradable stents were used as a rescue option. RESULTS:  Biodegradable stents provided immediate improvement for all of the patients, and Gastrografin studies were leak-free 2 days after the procedure. All patients were started on oral feeding and discharged home within 5 – 6 days later. Minimum outpatient follow-up of 8 weeks was achieved with no issues. Follow-up endoscopy was performed 2 – 3 months later in three patients and showed completely resorbed stents. The only drawback was the mucosal reaction to the stent causing dysphagia in two patients, who eventually needed esophageal dilatation. CONCLUSION:  Biodegradable stents have the potential to provide a reasonable rescue option to manage post bariatric surgery leaks in patients who fail conventional endoscopic exclusion methods. However, data from larger studies are needed to collect information on which theoretical advantages/disadvantages of degradable biomaterials apply to real practice. © Georg Thieme Verlag KG 2018-06 2018-05-25 /pmc/articles/PMC5979196/ /pubmed/29868637 http://dx.doi.org/10.1055/a-0600-9562 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Al Lehibi, Abed
Al Balkhi, Areej
Al Mtawa, Abdullah
Al Otaibi, Nawaf
Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
title Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
title_full Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
title_fullStr Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
title_full_unstemmed Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
title_short Endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
title_sort endoscopic biodegradable stents as a rescue treatment in the management of post bariatric surgery leaks: a case series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979196/
https://www.ncbi.nlm.nih.gov/pubmed/29868637
http://dx.doi.org/10.1055/a-0600-9562
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