Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Table 1 Results of series on post-Gastric Roux-en-Y bypass anastomotic stricture balloon dilation

Ref.	No. patients	Time interval to stricture diagnosis (d)	No. of sessions	Success rate (%)	Balloon diameter	Complication rate (%)	Perforation rate (%)
Barba et al[36]	24	28-270	1-3	100	8-13 mm	0	0
Go et al[37]	38	53.9 (21-168)	1-6	95	12-16 mm	3 1 pneumothorax and pneumomediastinum	3
Rossi et al[38]	38	-	1-3	100	-	0	0
Carrodeguas et al[39]	94	52.7 (20-154)	1-4	99	-	2.1 Perforations	2.1
Catalano et al[40]	26	63 (28-63)	1-7	96.2	8-15 mm	3.8 Surgical revision for recurrent stenosis	0
Peifer et al[41]	43	49.7 (24-197)	1-3	93	9-20 mm	0.5 Surgical revision for recurrent stenosis	0
Caro et al[42]	111	56 (3-237)	1-4	100	6-18 mm	2.7 2 contained perforations 1 esophageal hematoma	1.8
Ukleja et al[43]	61	60 (30-180 )	1-5	100	6-18 mm	4.9 3 perforations	2.21
Mathew et al[44]	58	66.2 (12-365)	1-7	100	6-20 mm	3.2 Perforations	3.2
Da Costa et al[45]	105	90 (30-270)	1-4	100	6-20 mm	3.8 1 hemorrhage 3 perforations	1.81
Espinel et al[35]	22	126 (26-768)	1-4	100	12-20 mm	4.5 Small tear	0
Yimcharoen et al[46]	72	46 < 90 25 > 90	1-15	84.7 98% < 90 d 61% > 90 d	8-18 mm	1.3 1 perforation, pneumoperitoneum and death	1.3

¹Perforation rate of the dilations referred to the number of sessions. R: Retrospective; RYGB: Roux-en-Y gastric bypass.

Table 2 Results of endoscopic stenting in anastomotic and staple-line leaks after bariatric surgery

Ref.	Nº patients	Bariatric procedure	Time interval to stent	Type of stent	Success rate (%)	Complications rate1	Migration rate (%)	Nº of procedures	Time to fistula closure
Salinas et al[98]	17	RYGB	1-3 wk	PCSEMS	94	41% 1 migration, 2 mucosal tears, 4 stent obstruction by food	6	1.2 (1-2)	3.2 ± 1.2 mo
Eisendrath et al[99]	21	RYGB/ LGS/DS	31 d (14-199)	PCSEMS	81	14% 1 migration, 2 dysphagia due to tissue hyperplasia	5	1-6	NA
Eubanks et al[100]	13	RYGB/LGS	Acute leaks (11) Chronic leaks (2)	FCSEMS/FCSEPS	77	70% (not specified)	NA	NA	Acute leaks - 33 d Chronic leaks - 45 d
Blackmon et al[101]	10	RYGB/LGS	NA	FCSEMS/PCSEMS	100	NA	NA	NA	NA
Leenders et al[102]	11	RYGB/LSG	8 d (1-33)	FCSEMS	73	50% 3 disintegrated stent, 2 migration	17	2 (1-4)	16 wk (5-63)
El Mourad et al[103]	47	RYGB/LSG/DS	10.5 d (1-74)	PCSEMS	87	30% 1 mucosal stripping, 1 perforation, 1 dysphagia, 1 stricture, 1 bleeding 1 stent angulation, 7 migration	15	NA	44 d (3-90)
Orive-Calzada et al[104]	11	LSG	NA	FCSEMS	73	NA	NA	NA	NA
Alazmi et al[105]	17	LSG	< 1 wk (10) 1 wk-1 mo (6) > 1 mo (1)	PCSEMS	76	36% 2 bleeding, 3 dysphagia, 1 migration	6	NA	42 d (28-84)
Quezada et al[106]	29	RYGB/SG	8 d (0-104)	CSEMS	96.5	41% 10 migration, 1 stent fracture, 1 opening of blind end of alimentary limb	34	NA	82 d (2-352)
Murino et al[107]	91	RYGB/LSG	25 d (2-308)	PCSEMS	81	22% 5 bleeding, 2 perforation (1 death), 7 migration, 13 esophageal stricture	8	1 (1-7)	NA
Fishman et al[108]	26	LSG	< 1 wk (1) 1-6 wk (17) 7-12 wk (5) > 12 wk (3)	FCSEMS2	65	46% 4 severe stent intolerance (stent removal) 1 severe bleeding, 7 migration	27	NA	NA
Southwell et al[109]	21	LSG	< 1 wk (6) 1-6 wk (12) 7-12 wk (1) > 12 wk (2)	FCSEMS2/PCSEMS	95	86% 10 migration,, 2 esophageal strictures 1 leak due to erosion by the stent 5 severe intolerance (stent removal)	48	5 (2-13)	75 d (9-187)
Van Wezenbeek et al[110]	12	RYGB/LSG	8 d (0-24)	FCSEMS2	75	75% 7 migration, 1 perforation 1 perforation secondary to migration	67	2.4 (1-3)	38 d (28-49)
Shehab et al[111]	22	RYGB/LSG	11 d (3-30)	FCSEMS2	82	41% 1 perforation, 1 esophageal stricture, 4 migrations, 2 bleeding (1 death), 1 stent intolerance (removal)	18	2.8 (2-5)	6.8 wk (2-14)

¹Including migration. Dysphagia and intolerance were included when required endoscopic dilation and/or stent removal;

²Sleeve customized stents. R: Retrospective; RYGB: Roux-en-Y gastric bypass; LSG: Laparoscopic sleeve gastrectomy; DS: Duodenal switch; FCSEMS: Fully-covered self-expandable metal stent; PCSEMS: Partially-covered self-expanding metal stent; CSEMS: Covered self-expandable metal stent.

Table 3 Results of laparoscopy-assisted trans gastric endoscopic retrograde cholangiography in Roux-en-Y gastric bypass

Ref.	No. ERCP1	Success of CBD cannulation (%)	ERCP Findings	Operative time (min)	Complications related to ERCP	Complications related to laparoscopic transgastric access
Ceppa et al[144]	5	80 (4/5)	2 BDS/2 CBD stones/1 CBD sludge	NA	None	None
Patel et al[145]	6	100	4 BPS/1 CBD stones/1 normal	NA	None	None
Roberts et al[146]	5	100	2 BPS/2 SOD/1 CBD stone	64-93	None	None
Gutierrez et al[147]	23	100	3 CBC stone/1 PC/2 N/9 SOD/5 BPS/1 cholecystitis/1 BPS + SOD/1BSP+ PS	200 (98-138)	1 postERCP pancreatitis	17% 2 leak after g-tube removal/1 converted to open/1 gastrostomy site infection
Lopes et al[148]	9	89 (8/9)	3 BPS/1 CBD stone/2 N/2 SOD	89 (41-245)	2 postERCP pancreatitis	11% 1 pneumotorax
Bertin et al[149]	22	100 (20/20)2	18 SOD/4 Recurrent pancreatitis	226	1 retroperitoneal perforation	5% 1 hematoma of the abdominal wall
Richardson et al[150]	11	100	7 CBD stone/2 BPS/1 SOD/1 CP	NA	None	None
Saleem et al[151]	15	100	5 BPS/2 CBD stone/3 CBD sludge/1 PD/1 SOD/1 BPS + SOD/1 BPS + CBD stenosis/1 biliary leak	NA	None	None
Schreiner et al[152]	24	100	20 BPS/3 CBD stones/1 PC	172	1 postERCP pancreatitis	8% 1 enterocutaneous fistula
Falcão et al[153]	23	100	17 CBD stone/6 BPS 17 CBD stone/1 CBD sludge/1 BSP	93	1 postERCP pancreatitis	None
Snauwaert et al[154]	23	100	1 N/1 CBD transection	NA	None	9% 2 converted to open

¹After excluding laparoscopic trangastric access for gastroduodenoscopy and programmed open procedures;

²Two patients underwent minor papilla cannulation. R: Retrospective; ERCP: Endoscopic retrograde cholangiopancreatography; CBD: Common bile duct; BPS: Benign papillary stenosis; SOD: Sphincter of Oddi dysfunction; PC: Pancreatic cancer; CP: Chronic pancreatitis; PD: Pancreas divisum; BDS: Bile duct stones.