Title : Stent management of leaks after bariatric surgery: a systematic review and meta-analysis
Abstract:
Background: Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase postoperative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results. The aim of our study was to examine the safety and efficacy of the use of stents for the treatment of leakage after bariatric surgery.
Methods: We performed a systematic review and meta-analysis of self-expanding stent placement for the management of gastrointestinal leaks after obesity surgery. The overall proportion of successful leak closure, stent migration, and reoperation was analyzed as primary outcomes. Secondary outcomes were patients’ clinical characteristics, duration and type of stent, other stent complications, and mortality.
Results: A meta-analysis of studies reporting stents (between 2005 and 2020) was performed, including 488 patients. The overall proportion of successful leak closure was 85.89 % (95% CI, 82.52- 89.25%), the median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65 % (95% CI, 14.32-22.98%) and the overall proportion of reoperation was 13.54 % (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen’s κ value of 1.0. No deaths were caused directly by complications with the stent placement.
Conclusion: Self-expanding stents can be used for the management of gastrointestinal leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reintervention and stent migration represent a real problem with rates as high as 13.54% and 18.65 %, respectively. Therefore, more studies (probably, endoscopic combined methods) are still needed to establish a definitive basis for leak management after bariatric surgery and reduce migration rates
