Case Report
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World J Gastroenterol. Oct 28, 2013; 19(40): 6931-6933
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6931
Resolution of an esophageal leak and posterior gastric wall necrosis with esophageal self-expandable metal stents
Majid A Almadi, Abdulrahman M Aljebreen, Fahad Bamihriz
Majid A Almadi, Abdulrahman M Aljebreen, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
Majid A Almadi, Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, H3G 1A4, Canada
Fahad Bamihriz, Division of Surgery, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
Author contributions: Almadi MA, Aljebreen AM and Bamihriz F were attending doctors for the patient and contributed in writing and drafting the report and revising it critically for important intellectual content, and final approval of the version to be published.
Supported by The Research Group Project, Deanship of Scientific Research at King Saud University, No. RGP-VPP-279
Correspondence to: Dr. Majid Abdularahman Almadi, MBBS, FRCPC, MSc, Assistant Professor of Medicine, Division of Gastroenterology, King Khalid University Hospital, King Saud University, PO Box 2925 (59), Riyadh 11461, Saudi Arabia. maalmadi@ksu.edu.sa
Telephone: +966-1-4679167 Fax: +966-1-4671217
Received: June 2, 2013
Revised: July 1, 2013
Accepted: August 4, 2013
Published online: October 28, 2013
Processing time: 164 Days and 4.4 Hours
Abstract

The use of weight reduction surgeries has increased over the years with a higher proportion of these surgeries being sleeve gastrectomies, this has been associated with some complications including staple line leaks. We report a 32-year-old male who had undergone a laparoscopic gastric band surgery and subsequently a laparoscopic sleeve gastrectomy, this was complicated by both an staple line leak at the gastroesophageal junction as well as a large (> 4 cm) posterior gastric wall defect due to gastric wall necrosis. We used two co-axially inserted self-expandable stents (SEMS) in the management of this patient, 5 stents were used over repeated endoscopy sessions and 20 wk. Both defects had resolved without the need for surgical intervention.This is the first reported case were SEMS are used for both a staple line leak as well as a gastric wall defect. We also review the literature on the use of SEMS in the management of leaks post weight reduction surgeries.

Keywords: Stents, Self-expandable metal stents, Laparoscopic sleeve gastrectomy, Staple line leak, Esophageal leak, Gastric necrosis

Core tip: Management of staple line leaks has incorporated, in recent years, a non-surgical approach which mainly depends on elimination of oral intake, parenteral nutrition, antimicrobial therapy, and drainage procedures and more recently the use of esophageal self-expandable metal stents for sealing of these leaks as well as the induction of tissue hyperplasia that would close these leaks. This case is the first, to our knowledge, that reports the successful use of self-expandable metal stents for the closure of a posterior gastric wall necrosis as a consequence of repeated bariatric surgery.