Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2017; 9(6): 267-272
Published online Jun 16, 2017. doi: 10.4253/wjge.v9.i6.267
Utility of the balloon-overtube-assisted modified over-the-wire stenting technique to treat post-sleeve gastrectomy complications
Ana Ponte, Rolando Pinho, Luísa Proença, Joana Silva, Jaime Rodrigues, Mafalda Sousa, João Carlos Silva, João Carvalho
Ana Ponte, Rolando Pinho, Luísa Proença, Joana Silva, Jaime Rodrigues, Mafalda Sousa, João Carlos Silva, João Carvalho, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, 4434-502 Porto, Portugal
Author contributions: Ponte A and Pinho R designed the study, performed the research, analyzed the data and wrote the paper; Proença L, Silva J, Rodrigues J, Sousa M, Silva JC and Carvalho J performed the research and analyzed the data.
Institutional review board statement: The study was reviewed and approved by review board of Centro Hospitalar de Vila Nova de Gaia/Espinho.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ana Ponte, MD, Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Rua Conceicao Fernandes, 4434-502 Porto, Portugal. ana.isabel.ponte@chvng.min-saude.pt
Telephone: +351-96-5651833 Fax: +351-22-7868369
Received: January 28, 2017
Peer-review started: February 10, 2017
First decision: March 28, 2017
Revised: April 7, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: June 16, 2017
Processing time: 139 Days and 6.2 Hours
Abstract
AIM

To describe a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy in post-sleeve gastrectomy (SG) complications.

METHODS

Between January 2010 and December 2015, all patients submitted to an endoscopic stenting procedure to treat a post-SG stenosis or leakage were retrospectively collected. Procedures from patients in which the stent was deployed using the balloon-overtube-assisted modified over-the-wire (OTW) stenting technique were described. The technical success, corresponding to proper placement of the stent in the stomach resulting in exclusion of the SG leak or the stenosis, was evaluated. Complications related to stenting were also reported.

RESULTS

Five procedures were included to treat 2 staple line leaks and 3 stenoses. Two types of stents were used, including a fully covered self-expandable metal stent designed for the SG anatomy (Hanarostent, ECBB-30-240-090; M.I. Tech, Co., Ltd, Seoul, South Korea) in 4 procedures and a biodegradable stent (BD stent 019-10A-25/20/25-080, SX-ELLA, Hradec Kralove, Czech Republic) in the remaining procedure. In all cases, an overtube was advanced with the endoscope through the SG to the duodenum. After placement of the guidewire and removal of the endoscope, the stent was easily advanced through the overtube. The overtube was pulled back and the stent was successfully deployed under fluoroscopic guidance. Technical success was achieved in all patients.

CONCLUSION

The adoption of a modified technique of deployment of OTW stents using an overtube may represent an effective option in the approach of SG complications.

Keywords: Bariatric surgery; Sleeve gastrectomy; Stenosis; Anastomotic leaks; Balloon-overtube; Stent

Core tip: Sleeve gastrectomy (SG) represents a type of bariatric surgery, whose postoperative complications include anastomotic leaks and strictures. Endoscopic treatment may encompass stenting, which may be technically challenging in angulated and tortuous SG anatomies. Furthermore, the delivery systems of some stents used in this indication are larger and less flexible. These aspects may result in recurrent kinking of the delivery system of the stent preventing its correct progression in the altered gastric cavity. Therefore, the adoption of a modified technique of deployment of stents using the overtube developed for balloon-assisted enteroscopy may represent an effective option to overcome those technical difficulties.