Abstract
Endoscopy is the gold standard for the treatment of postoperative gastric leaks (GL). Large fistulas are associated with high rate of treatment failure. The objective of this study was to assess the clinical efficacy of a combining technique using a covered stent (CS) crossing through pigtails (PDs) for large postsurgical GL leaks. All consecutive patients with large (> 10mm) postsurgical GL treated endoscopically with a combination of a CS and PDs were included in a single-center retrospective study. The primary endpoint was the rate of GL closure. A total of 29 patients were included. Twenty-five patients underwent sleeve gastrectomy. The fistula (median diameter 15mm) was diagnosed 6days (IQR 4-9) after surgery. Technical success was observed in all procedures. After a median follow-up of 10.7months (IQR 3.8-20.7), GL closure was observed in 82.7% with a median time of 63days (IQR 40-90). Surgical management was finally necessary in four patients after a median of 186days (IQR 122-250). No complications related to combined endoscopic treatment were observed especially stent migration during the follow-up. An endoscopic strategy combining CS crossing through PDs appears to be effective, safe and well tolerated for the treatment of large GL.
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