Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: A multicenter study

Abstract Background The management of laparoscopic sleeve gastrectomy (LSG) leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel fully covered stents with a larger proximal flare to limit migration designed specifically to treat post-sleeve leaks were recently introduced. Aim The aim of this study is to evaluate the safety and efficacy of a novel stent specifically designed for post-sleeve leaks treatment. Methods This is a multicenter retrospective study, including patients with acute and early post-LSG leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. Results Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the post pyloric (POST) and 7 in the pre-pyloric (PRE) position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21,62%) and all were in a POST position. AE post stent removal were also evaluated (PRE:57.14% vs POST:33.3%, p =0.45). There was no difference between PRE and POST position in the severe AE analysis. Conclusions This novel large-caliber fully-covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate, and may be associated with higher overall severe adverse event rates. Avoiding placement in the post-pyloric position may help mitigate migration risk, however, due to the risk profile this stent should be used with caution.