Endoscopic Administration of Combined Autologous Mesenchymal Stem Cells and Platelet-Rich Plasma for the Treatment of Gastric Staple Line Leaks After Sleeve Gastrectomy.

Abstract

Gastric staple line leak treatment after laparoscopic sleeve gastrectomy (LSG) remains challenging. Regenerative medicine is gaining place in the accelerated treatment of damaged tissues. This study presents the first series of gastric leak treatment after LSG using endoscopic intragastric administration of combined autologous mesenchymal stem cells (MSC) and platelet-rich plasma (PRP). MSC-PRP harvesting and endoscopic administration techniques are described in detail. Data were prospectively gathered and analyzed. Primary endpoints were morbidity/mortality rates and fistula closure time. Twelve patients (9 women, 3 men) were included. Median age was 41.5years, median weight 105.5kg and median BMI 38.9kg/m2. Median time to gastric staple line leak detection was 10days post-LSG. Median time between re-laparoscopy and MSC-PRP administration was 5days. MSC-PRP endoscopic administration was successfully performed and tolerated by all patients, with median procedure duration of 27min and minimal blood loss. Four postoperative complications were noted: two patients with increased tibial pain at tibial puncture site, one with tibial hematoma, and one with epigastric pain/dysphagia. Median length of hospital stay was 1day. Gastric leak healing occurred after a median of 14days, only two patients requiring a second MSC-PRP endoscopic injection. Median follow-up was 19months, all patients being in good health at last contact. Endoscopic administration of combined autologous MSC-PRP seems to be a good option for treatment of gastric leaks after sleeve gastrectomy. It is a challenging procedure that should be performed in specialized bariatric centers by expert bariatric surgeons and endoscopists after meticulous patient selection.