P1953 - A Case of Laproscopic Sleeve Gastrectomy Leak Managed by Esophageal Stenting

Pranay Srivastava, MD¹, Bobby Jacob, MD², Shino Prasandhan, MD¹, Charudatta Wankhade, MD¹, Kevin Yeroushalmi, MD¹, Deepthi Kagolanu, MD¹, Syed Karim, MD¹, Kaleem Rizvon, MD^1
1Nassau University Medical Center, East Meadow, NY; ²Nassau University Medical Center, Lake Grove, NY

Introduction: Laparoscopic sleeve gastrectomy (LSG) is effective bariatric surgery method. In the US alone, 125,318 LSGs were performed in 2016, which accounted for 58% of all bariatric procedures performed. The most common site of leaks are at the gastrojejunal anastomosis or proximal staple line due to the long staple line and high intraluminal pressures. The rate of staple-line leakage has been reported to be up to 5%. Endoscopic esophagogastric stenting has been increasingly preferred method of treatment for gastrectomy leaks. We present a young patient who had a gastrectomy leak 8 years after her original surgery.

Case Description/Methods: 26 yo female with history of laparoscopic sleeve gastrectomy in 2014 who presented in 2020 with abdominal burning for 3 weeks. CT scan revealed 4.3 cm, well-circumscribed thick rim fluid collection adjacent to the suture line containing air. She was managed surgically s/p wash out and JP drain placement. Upper endoscopy performed revealed a 2 mm perforation adjacent to the superior aspect of the staple line. Due to chronicity of the leak, argon plasma coagulation was performed at the margins of the defect to assist in healing prior to deploying multiple clips to close the defect. The Boston Scientific WallFlex fully covered esophageal stent was placed over the guidewire and advanced into the proximal stomach. Multiple techniques were utilized with the use of raptor forceps and a snare to advance the stent delivery system distal to the mucosal defect which was successful and the stent was deployed from the distal stomach to 35 cm from the incisors, confirmed under fluoroscopy. The stent was removed within 1 month due to development of pain and the perforation was found to be closed.

Discussion: Laparoscopic sleeve gastrectomy is a common complication of bariatric surgery. Although LSG does not involve an anastomosis, it is more susceptible to a leak than Roux-en-Y Gastric Bypass is (2.4% vs. 0.7%). Post LSG leaks are characterized by timing; acute (within seven days), early (within one to six weeks), late (after six weeks), and chronic (after 12 weeks). Unstable patient characterized as febrile with signs of infections have better outcomes with surgical management. Patient whom are stable can be managed by less invasive methods such as endoluminal stenting. Our case was unique in that the patient presented after eight years from the gastrectomy which was initially managed by APC and endoclips followed by stenting.


Figure: Deployed esophogastric stent bypassing the perforation on the left s/p endoclips


Disclosures:
Pranay Srivastava indicated no relevant financial relationships.
Bobby Jacob indicated no relevant financial relationships.
Shino Prasandhan indicated no relevant financial relationships.
Charudatta Wankhade indicated no relevant financial relationships.
Kevin Yeroushalmi indicated no relevant financial relationships.
Deepthi Kagolanu indicated no relevant financial relationships.
Syed Karim indicated no relevant financial relationships.
Kaleem Rizvon indicated no relevant financial relationships.


Pranay Srivastava, MD¹, Bobby Jacob, MD², Shino Prasandhan, MD¹, Charudatta Wankhade, MD¹, Kevin Yeroushalmi, MD¹, Deepthi Kagolanu, MD¹, Syed Karim, MD¹, Kaleem Rizvon, MD¹. P1953 - A Case of Laproscopic Sleeve Gastrectomy Leak Managed by Esophageal Stenting, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.