World Congress of Gastroenterology

WCOG 2019


 
Endoscopic management of post sleeve gastrectomy complications, Where are we now?
AHMED EL-MIKKAWY 1

1- THEODOR BILHARZ RESEARCH INSTITUTE
 
Background/Aims:

With the current epidemic of obesity and the last reports of world health organization more than 2.1 billion adults were estimated to be overweight and obese, 25 million have classical criteria necessitating bariatric surgery. Leak, stenosis and bleeding are the most met perioperative complications, which requires multidisciplinary team including; Intensivist, endoscopist, interventional radiologist and surgeon. The endoscopic management is a simple, non- invasive technique. Our aim is to the study the incidence of post sleeve gastrectomy (SG) complications and the role of endoscopic management

Materials and Methods:

This is a randomized study conducted on 200 patients underwent SG from 2015-18. They were divided into 3 groups; leak group 154 patients (77%), stenosis group 40 patients (20%) and bleeding group 10 patients (5%). The endoscopic management included; stenting using MEGA stents ± over the scope clips (OVESCO), or one or multiple double pigtail (DPDs) drain (for leak), balloon dilation ± stenting (for stenosis), and hemostasis for bleeding by either heamoclips or coagulation

Leaks are either, simple (only leak) or associated with the presence of a stricture beneath. They are classified according to the timing of clinical signs into; early (within 2 weeks), intermediate (2-6 weeks) and late (>6 weeks) and according to orifice size, into; small (<1cm) and large (>1cm)

 

Results:

There was female predominance; mean age was 33.6 ± 13.8 years, median body mass index pre-operative was 37.9 ± 4.3. Incidence of peri-operative complications was (3.8%) of the total number done. In leak group, median time post-operative was 3.6 days. 103 Patients (66.9%) underwent MEGA stenting ± OVESCO clipping, 37 Patients (24.02%) needed draining the leak collection into gastric lumen using DPDs, 13 patients (8.4%) needed both laparoscopic or open surgery and four of them died

In stenosis group, median time post-operative was 13 days,  7 patients (17.5%) underwent one session of balloon dilation, 26 patients (65%) needed multiple sessions of balloon dilation > 2 times, 7 patients (17.5%) needed stenting,  1 patient (0.25%) needed gastric bypass with no mortalities

In bleeding group, bleeding was the earliest complication and endo-clips stopped bleeding in 7 (70%) patients

 

Conclusion:

Endoscopic management is simple and non-invasive, promising in control post bariatric complications and reduce the need of re-surgery but it takes time and depends on the expertise of the endoscopist

Keywords:

Sleeve gastrectomy, leak, stenosis