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


Fayad L., Simsek C. , Oleas R., Ichkhanian Y., Fayad G. E. , Ngamreungphong S., ...More

OBESITY SURGERY, vol.29, no.11, pp.3484-3492, 2019 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 11
  • Publication Date: 2019
  • Doi Number: 10.1007/s11695-019-04021-0
  • Title of Journal : OBESITY SURGERY
  • Page Numbers: pp.3484-3492

Abstract

BackgroundThe 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.ObjectivesTo assess the technical feasibility, clinical efficacy, and safety of endoscopically secured FCSEMS in the stomach for >30 days.MethodsA 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.ResultsFifteen 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.ConclusionsA 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.