Radiological stent placement of post sleeve gastrectomy leak: efficacy, imaging features and post-procedure complications

Giovanni Scavone; Giuseppe Caltabiano; Corrado Inì; Federica Castelli; Daniele Falsaperla; Antonio Basile; Luigi Piazza; Antonio Scavone

doi:10.1016/j.heliyon.2022.e08857

Radiological stent placement of post sleeve gastrectomy leak: efficacy, imaging features and post-procedure complications

Heliyon. 2022 Jan 28;8(1):e08857. doi: 10.1016/j.heliyon.2022.e08857. eCollection 2022 Jan.

Authors

Giovanni Scavone¹, Giuseppe Caltabiano¹, Corrado Inì², Federica Castelli¹, Daniele Falsaperla², Antonio Basile², Luigi Piazza³, Antonio Scavone¹

Affiliations

¹ Department of Diagnostic Radiology, Neuroradiology and Interventional Radiology, "Garibaldi Centro" Hospital, Piazza Santa Maria di Gesù, 5, 95124 Catania CT, Italy.
² Department of Radiodiagnostic and Radiotherapy Unit, University Hospital Policlinico "G.Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
³ General and Emergency Surgery Department, "Garibaldi Centro" Hospital, Piazza Santa Maria di Gesù, 5, 95124 Catania CT, Italy.

Abstract

Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric procedure. The primary and insidious early post-SG complication is the gastric leak (GL). In literature, there are many studies describing the endoscopic stent placement as treatment of GL and few studies about stent placement performed by interventional radiology under fluoroscopic guide. Our aims were to describe the radiological stent placement technique, to compare endoscopic and radiological stent placement, to illustrate normal diagnostic features and summarise the incidence of complications after stent placement, removal, and their imaging features. This was a single centre retrospective study of 595 patients who underwent SG between 2011 and 2019. Inclusion criteria: patients who developed GL after SG and treated with gastro-oesophageal stent placement by endoscopy or interventional radiology; availability of medical history and imaging studies; follow-up time after stent removal (1 year). The rates of technical success, clinical success and complications after stent placement and removal were collected and compared between the two methods of stent positioning. A total of 17/595 (2.8%) patients developed a radiologically diagnosed GL after SG. The type II-III GLs (15/17) were treated with endoscopic or radiological stent placement. 9/15 (60%/Group A) patients underwent gastro-oesophageal stenting by interventional radiology and 6/15 (40%/Group B) were treated with endoscopic stent placement. The technical and clinical success rate was 100% for both groups. Stent migration occurred in 22% and 27% for Group A and B respectively. Post-extraction stenosis was the main late complication, occurring in 22% in Group A and 0% in Group B. Gastro-esophageal stent placement performed by interventional radiologists is a valid "mini-invasive" treatment for GL. This procedure is not inferior to endoscopic positioning regarding efficacy, periprocedural and postprocedural complication rate. It's necessary to be familiar with radiological findings after stent placement and removal. Computed tomography (CT) scan is the main radiological technique to identify stent placement complications. Upper gastrointestinal (UGI) series are the first radiological procedures used to detect late complications after stent removal.

Keywords: Bariatric surgery; Imaging; Obesity; Radiological stent placement; Sleeve gastrectomy.