VideoGIE
Novel technique for the management of staple line leaks after sleeve gastrectomy
Figure 1. Overlapping fully covered self-expandable metal stents. A, Fluoroscopic image revealing the proximal stent covering the leak sites and the end of the distal stent in the duodenum. B, Endoscopic image during suturing of the 2 stents to each other.
Laparoscopic vertical sleeve gastrectomy (SG) is now the most common bariatric surgical procedure performed in the United States. Staple line leaks occur in 1% to 7% of these patients. Endoscopic and percutaneous management is preferred because there is a significant morbidity associated with surgical reintervention. A 32-year-old man presented for management of late proximal staple line leaks after SG. The patient was initially treated with a percutaneous drain and insertion of an esophageal fully covered self-expandable metal stent (FCSEMS) for 4 weeks. However, the 2 leak sites persisted, and each were closed with individual over-the-scope clips. Two partially overlapping FCSEMSs were then inserted such that they extended from the distal esophagus to the duodenum (Video 1, available online at www.giejournal. org). The proximal FCSEMS was secured to the esophagus with endoscopic sutures. Additionally, the 2 FCSEMSs were secured to each other by using endoscopic sutures
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
748 GASTROINTESTINAL ENDOSCOPY Volume 82, No. 4 : 2015
(Fig. 1). At 8 weeks, the sutures were cut, and the FCSEMSs removed 1 at a time with no evidence of residual leak. The percutaneous drain was removed; the patient remains asymptomatic. We demonstrate closure of staple line leaks after SG with the combination of primary closure and diversion therapy. Additionally, we show that 2 FCSEMSs can be sutured together to mimic a single long FCSEMS. DISCLOSURE Dr Khashab is a consultant for Boston Scientific, Xlumena, and Olympus America and has received research support from Cook Medical. All other authors disclosed no financial relationships relevant to this publication. Vivek Kumbhari, MD, Alan H. Tieu, MD, Jennifer X. Cai, MD, Patrick I. Okolo III, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions; Michael A. Schweitzer, MD, Department of Surgery, The Johns Hopkins Medical Institutions, Mouen A. Khashab, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2015.05.033
www.giejournal.org
Novel technique for the management of staple line leaks after sleeve gastrectomy
Figure 1. Overlapping fully covered self-expandable metal stents. A, Fluoroscopic image revealing the proximal stent covering the leak sites and the end of the distal stent in the duodenum. B, Endoscopic image during suturing of the 2 stents to each other.
Laparoscopic vertical sleeve gastrectomy (SG) is now the most common bariatric surgical procedure performed in the United States. Staple line leaks occur in 1% to 7% of these patients. Endoscopic and percutaneous management is preferred because there is a significant morbidity associated with surgical reintervention. A 32-year-old man presented for management of late proximal staple line leaks after SG. The patient was initially treated with a percutaneous drain and insertion of an esophageal fully covered self-expandable metal stent (FCSEMS) for 4 weeks. However, the 2 leak sites persisted, and each were closed with individual over-the-scope clips. Two partially overlapping FCSEMSs were then inserted such that they extended from the distal esophagus to the duodenum (Video 1, available online at www.giejournal. org). The proximal FCSEMS was secured to the esophagus with endoscopic sutures. Additionally, the 2 FCSEMSs were secured to each other by using endoscopic sutures
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
748 GASTROINTESTINAL ENDOSCOPY Volume 82, No. 4 : 2015
(Fig. 1). At 8 weeks, the sutures were cut, and the FCSEMSs removed 1 at a time with no evidence of residual leak. The percutaneous drain was removed; the patient remains asymptomatic. We demonstrate closure of staple line leaks after SG with the combination of primary closure and diversion therapy. Additionally, we show that 2 FCSEMSs can be sutured together to mimic a single long FCSEMS. DISCLOSURE Dr Khashab is a consultant for Boston Scientific, Xlumena, and Olympus America and has received research support from Cook Medical. All other authors disclosed no financial relationships relevant to this publication. Vivek Kumbhari, MD, Alan H. Tieu, MD, Jennifer X. Cai, MD, Patrick I. Okolo III, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions; Michael A. Schweitzer, MD, Department of Surgery, The Johns Hopkins Medical Institutions, Mouen A. Khashab, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2015.05.033
www.giejournal.org
