Rebibo Lionel, Hakim Sami, Brazier Franck, Dhahri Abdennaceur, Cosse Cyril, Regimbeau Jean-Marc
Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
Department of Gastroentrology, Amiens University Hospital, Amiens, France.
Surg Obes Relat Dis. 2016 Sep-Oct;12(8):1577-1584. doi: 10.1016/j.soard.2016.04.026. Epub 2016 Apr 28.
Covered stent (CS) is required when gastric leak (GL) after sleeve gastrectomy is combined with gastric stenosis (GS) or when a large (>2 cm in diameter) gastric fistula is present (increasing the likelihood of double pigtail stent [DPS] migration).
To compare the results of our previous endoscopic management of large GL or GS associated with GL (using CS only) with those of our new endoscopic treatment (using combined CS and DPS).
University hospital, France, public practice.
Between January 2009 and June 2015, all patients treated for large GL or GS associated with GL after sleeve gastrectomy (n = 20 patients) were included. Our previous endoscopic management required CS placement (CS group), whereas our new endoscopic treatment required combined CS and DPS placement (CS+DPS group). The primary efficacy endpoint was the treatment duration after CS placement until closure of the GL. The secondary efficacy endpoints were the number of endoscopic procedures, the stent migration rate, and the failure rate.
Nine patients were treated by CS only (CS group), whereas 11 patients were treated by both CS and DPS (CS+DPS group). The median time to GL closure after CS placement was 84 days (33-130) in the CS group and 32 days (26-89) in the CS+DPS group (P≤.05). The median number of endoscopic procedures at the time of CS placement was 2 (1-3) in the CS group and 1 (1-2) in the CS+DPS group (P≤.05). The stent migration rate after CS placement was 33.3% in the CS group and 0% in the CS+DPS group (P = .21), and the failure rate was 11% and 0% (P = .36).
The combination of CS and DPS constitutes an effective treatment for large GL or GS associated with GL, allowing significantly fewer endoscopic procedures and a shorter treatment duration.
当袖状胃切除术后胃漏（GL）合并胃狭窄（GS）或存在较大（直径>2 cm）胃瘘时（增加双猪尾支架[DPS]移位的可能性），需要使用覆膜支架（CS）。
比较我们之前对与GL相关的大型GL或GS进行内镜治疗（仅使用CS）的结果与我们新的内镜治疗（使用CS和DPS联合）的结果。
法国大学医院，公共医疗实践。
纳入2009年1月至2015年6月期间所有因袖状胃切除术后与GL相关的大型GL或GS接受治疗的患者（n = 20例）。我们之前的内镜治疗需要放置CS（CS组），而我们新的内镜治疗需要联合放置CS和DPS（CS + DPS组）。主要疗效终点是放置CS后直至GL闭合的治疗持续时间。次要疗效终点是内镜操作次数、支架移位率和失败率。
仅9例患者接受CS治疗（CS组），而11例患者接受CS和DPS联合治疗（CS + DPS组）。CS组放置CS后GL闭合的中位时间为84天（33 - 130天），CS + DPS组为32天（26 - 89天）（P≤0.05）。CS组放置CS时内镜操作的中位次数为2次（1 - 3次），CS + DPS组为1次（1 - 2次）（P≤0.05）。CS组放置CS后的支架移位率为33.3%，CS + DPS组为0%（P = 0.21），失败率分别为11%和0%（P = 0.36）。
CS和DPS联合构成了一种治疗与GL相关的大型GL或GS的有效方法，可显著减少内镜操作次数并缩短治疗持续时间。
