de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World J Gastroenterol 2023; 29(7): 1173-1193 [PMID: 36926665 DOI: 10.3748/wjg.v29.i7.1173]
Corresponding Author of This Article
Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, Research Fellow, Professor, Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 255, 6 Andar, Bloco 3, Cerqueira Cesar, São Paulo 05403010, Brazil. dthmoura@hotmail.com
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Gastroenterology & Hepatology
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Minireviews
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de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World J Gastroenterol 2023; 29(7): 1173-1193 [PMID: 36926665 DOI: 10.3748/wjg.v29.i7.1173]
World J Gastroenterol. Feb 21, 2023; 29(7): 1173-1193 Published online Feb 21, 2023. doi: 10.3748/wjg.v29.i7.1173
Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations
Victor Lira de Oliveira, Alexandre Moraes Bestetti, Roberto Paolo Trasolini, Eduardo Guimarães Hourneaux de Moura, Diogo Turiani Hourneaux de Moura
Victor Lira de Oliveira, Alexandre Moraes Bestetti, Eduardo Guimarães Hourneaux de Moura, Diogo Turiani Hourneaux de Moura, Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
Roberto Paolo Trasolini, Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 021115, United States
Author contributions: de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH performed the conception and design of the work; de Oliveira VL, de Moura DTH, Bestetti AM drafted the manuscript; de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH contributed to the critical review of the manuscript for important intellectual contents; de Moura DTH, Trasolini RP, de Moura EGH contributed to the manuscript supervision; Trasolini RP revised the manuscript for English language polishing requirements; de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH contributed to the approval of the version to be published, have participated in conceptualizing the research or content of the manuscript, in writing or critically editing the manuscript, and/or in analysis of data presented in the manuscript; Consent to submit has been received from all co-authors.
Conflict-of-interest statement: Dr. Eduardo Guimarães Hourneaux de Moura reports personal fees from Boston Scientific, personal fees from Olympus, outside the submitted work; Dr. Diogo Turiani Hourneaux de Moura reports personal fees from Bariatek, outside the submitted work; The other authors reported no potential conflict of interest.
Corresponding author: Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, Research Fellow, Professor, Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 255, 6 Andar, Bloco 3, Cerqueira Cesar, São Paulo 05403010, Brazil. dthmoura@hotmail.com
Received: October 6, 2022 Peer-review started: October 6, 2022 First decision: November 15, 2022 Revised: November 28, 2022 Accepted: January 30, 2023 Article in press: January 30, 2023 Published online: February 21, 2023 Processing time: 137 Days and 10 Hours
Abstract
Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
Core Tip: Post-surgical leaks and fistulas are the most feared complications of bariatric surgery. Endoscopic therapy is essential for effective management of these conditions. Several endoscopic techniques are available, and this review aims to clarify their mechanisms of action, basic principles, and optimal approach for each situation based on a detailed literature review as well as the authors’ personal experience.
