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Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study.
de Moura, Diogo Turiani Hourneaux; de Moura, Eduardo Guimarães Hourneaux; Neto, Manoel Galvão; Jirapinyo, Pichamol; Teixeira, Newton; Orso, Ivan; Quadros, Luiz Gustavo; Amorim, Artagnan; Medeiros, Filipe; Neto, Durval Rosa; de Siqueira Neto, João; Albano, Alvaro; de Sousa, Luiz Henrique; Almeida, Delano; Marchetti, Igor Antunes; Ivano, Flávio; de Lima, João Henrique Felicio; Falcão, Marcelo; Thompson, Christopher C.
Afiliação
  • de Moura DTH; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • de Moura EGH; Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
  • Neto MG; Endovitta Institute, São Paulo, Brazil; Florida International University, Miami, Florida.
  • Jirapinyo P; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
  • Teixeira N; Newton Teixeira Gastroenterologia, Rio de Janeiro, Brazil.
  • Orso I; Gastroclínica Cascavel, Cascavél, Brazil.
  • Quadros LG; Kaiser Clínica, São José do Rio Preto, Brazil.
  • Amorim A; Hospital Nove de Julho, São Paulo, Brazil.
  • Medeiros F; Hospital Wilson Rosado, Mossoró, Brazil.
  • Neto DR; Hospital Português, Salvador, Brazil.
  • de Siqueira Neto J; Universidade Federal do Espírito Santo, Vitória, Brazil.
  • Albano A; Santa Casa de Ilhéus, Ilhéus, Brazil.
  • de Sousa LH; Clínica Cirúrgica Digestiva e Obesidade, Goiania, Brazil.
  • Almeida D; Instituto do Aparelho Digestivo, Vitória da Conquista, Brazil.
  • Marchetti IA; Unimed Sorocaba, Sorocaba, Brazil.
  • Ivano F; Hospital Sugisawa, Curitiba, Brazil.
  • de Lima JHF; Hospital das Clínicas da Universidade Federal do Paraná, Curutiba, Brazil.
  • Falcão M; Hospital Santo Amaro, Salvador, Brazil; Hospital Aliança, Salvador, Brazil.
  • Thompson CC; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: cthompson@hms.harvard.edu.
Surg Obes Relat Dis ; 15(8): 1241-1251, 2019 Aug.
Article em En | MEDLINE | ID: mdl-31262650
BACKGROUND: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SETTING: Multicenter retrospective study. METHODS: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. RESULTS: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. CONCLUSIONS: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cirurgia Bariátrica / Fístula Anastomótica / Gastrectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Surg Obes Relat Dis Assunto da revista: METABOLISMO Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cirurgia Bariátrica / Fístula Anastomótica / Gastrectomia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Surg Obes Relat Dis Assunto da revista: METABOLISMO Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos