Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy.
Surg Obes Relat Dis. 2021 Aug;17(8):1432-1439. doi: 10.1016/j.soard.2021.03.013. Epub 2021 Mar 23.
Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases.
To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG.
Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center.
EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents.
A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818).
Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
内镜在肥胖症手术后不良事件（AE）的管理中起着关键作用。袖状胃切除术（SG）后，漏、瘘和术后积液的发生率可达 10%。
评估内镜内引流（EID）治疗 SG 后漏、瘘和积液的疗效和安全性。
回顾性、观察性、单中心研究，患者来自多个减重外科系转诊至内镜转诊中心。
EID 作为治疗 SG 后漏、瘘和积液的一线治疗方法。漏和瘘采用双猪尾支架（DPS）置入以保证内引流和二期腔隙闭塞。积液采用内镜超声（EUS）引导下 DPS 或管腔贴合金属支架置入治疗。
共有 617 例患者（83.3%为女性；平均年龄 43.1 岁）纳入本研究，其中漏（n=300，48.6%）、瘘（n=285，46.2%）和积液（n=32，5.2%）。中位随访时间为 19.5 个月。总体临床成功率为 84.7%，EID 失败后 15.3%的患者需要再次手术。根据 AE 类型，临床成功率分别为 89.5%、78.5%和 90%。在随访期间，有 10 例（1.8%）复发。内镜治疗相关 AE 共 28 例（4.5%）。单因素 logistic 回归分析显示，EID 失败的预测因素为瘘（OR 2.012）、联合内镜方法（OR 2.319）、需要紧急手术（OR 1.755）和先前的内镜治疗（OR 4.818）。
早期 EID 治疗 SG 后漏、瘘和术后积液似乎是一种安全有效的一线治疗方法，具有良好的长期效果。
