Safety and Efficacy of Endoscopically Secured Fully Covered Self-Expandable Metallic Stents (FCSEMS) for Post-Bariatric Complex Stenosis.

Abstract

BACKGROUND:

The use of fully covered self-expandable metallic stents (FCSEMS) has opened the door to treat stenosis in the post-bariatric stomach. We hypothesized that endoscopically securing a FCSEMS would be technically feasible, effective, and safe for > 30-day dwell time.

OBJECTIVES:

To assess the technical feasibility, clinical efficacy, and safety of endoscopically secured FCSEMS in the stomach for > 30 days.

METHODS:

A retrospective review (September 2016 to April 2018) of consecutive patients who underwent FCSEMS suturing in the stomach at a single academic institution was reviewed. Technical success, stent dwell time, symptoms, and adverse events were recorded.

RESULTS:

Fifteen patients (median age of 49 (31-70)) were included. Stents were inserted for gastrojejunal (GJ) stricture or gastric stenosis in 9/15 and 6/15 of patients, respectively. All procedures were technically successful (100%). Immediate and short-term clinical success (prior to stent removal) was 100% in patients who did not have stent migration. Stent migration was seen in 3 cases (20%) after a median dwell time of 211 days. However, 2/3 (66.6%) had not attended their scheduled removal. Recurrence of symptoms after stent removal was seen in 53.3% of patients with 40% undergoing repeat stenting. Median stent dwell was 117 (30-342) days. Sixty percent and 33% of patients had stent dwell of at least 90 and 180 days, respectively.

CONCLUSIONS:

A FCSEMS, if secured, may be safe and effective for even > 90-day dwell time in the post-bariatric stomach and may result in long-term clinical success for GJ stricture after stent removal.

• Authors: Lea Fayad, Cem Simsek, Roberto Oleas, Yervant Ichkhanian, Georges E Fayad, Saowanee Ngamreungphong, Michael Schweitzer, Andreas Oberbach, Anthony N Kalloo, Mouen A Khashab, Vivek Kumbhari
• Journal: Obesity surgery (Obes Surg) Vol. 29 Issue 11 Pg. 3484-3492 (11 2019) ISSN: 1708-0428 [Electronic] United States
• PMID: 31254212 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Bariatric Surgery (adverse effects)
• Constriction, Pathologic (etiology, surgery)
• Device Removal (statistics & numerical data)
• Endoscopy, Gastrointestinal (adverse effects, methods)
• Equipment Design (adverse effects)
• Female
• Humans
• Male
• Middle Aged
• Obesity, Morbid (surgery)
• Postoperative Complications (etiology, surgery)
• Prosthesis Implantation (adverse effects, methods)
• Recurrence
• Reoperation (adverse effects, instrumentation, methods)
• Retrospective Studies
• Self Expandable Metallic Stents (adverse effects)
• Time Factors
• Treatment Outcome