Table 2.
Clipping in the management of post-bariatric leak/fistula—characteristics of studies, included patients, and leak/fistula occurrence
| Study | Study type (n) | Study information/additional treatmet (n) | Clips alone (n) | Bariatric surgery | Age (range) | M/F | Time from surgery to leak/fistula | Symptoms |
|---|---|---|---|---|---|---|---|---|
| Tabibian/2017 | CR (1) | Combined radiological-endoscopic approach | 1 | GB | 65 | 0/1 | NA | Leak, intraabdominal abscess |
| Callabero/2016 | CR (1) | 1 | SG | 29 | 1/0 | 8 days | Abdominal pain | |
| Donatelli/2014 | CR (1) | Revision surgery as the first treatment, persistence of fistula 2 months later | 1 | GB | 43 | 0/1 | 4 years | Weight regain |
| Aly/2013 | CR (2) | Laparoscopic drainage, persistence of leak after 6 weeks (1) | 2 | SG |
58 44 |
0/2 |
8 days, 11 months |
Pain (2), fever (2), peritonitis (1) |
| Ritter/2013 | CR (2) |
Gastrojejunal anastomosis leak – percutaneous drainage Gastrogastric fistula due to ulcer—surgical revision, persistence of leak 2 months later |
2 | GB |
43 44 |
0/2 |
11 days 6 years |
Pain (2), fever (1), collection (1), malaise (1) |
| Iacopini/2010 | CR (1) | Band removal (erosion) and external drainage (26 months after placement) | 1 | LAGB | 45 | 0/1 | 2 weeks after band removal | Pain, abdominal abscess |
| Merrifield/2006 | CR (3) | Persistence of fistulas (diagnosed 10 days after GB) after percutaneous drainage | 1 | GB | NA | NA | 10 days | Pain, sepsis, abdominal abscesses |
| Lee/2018 | RS (21) | Different etiology (3 cases after bariatric surgery) | 3 | NA | 47, 49, 32 | 1/2 | 3–4 days | NA |
| Benosman/2018 | RS (26) |
Comparison of endoscopic drainage (pigtail catheter with and without other endoscopic techniques, n = 7): + OTSC: 3, OTSC + SEMS: 2, + SEMS: 2 vs endoscopic closing techniques alone: (n = 19): OTSC: 7, OTSC + SEMS: 5, SEMS: 7 Prior therapy: external drainage (10, 45.5%) |
7 | SG | 45.6 (± 8.9) | 7/19 | NA |
NA Abdominal collection in 84.6% of patients |
| Kim/2017 | RS |
Complications of LAGB in 26 patients (7.4%) including intragastric migration, gastric leaks and fistulas. Endoscopic treatment in 6 patients including gastric leaks (n = 2) and fistulas (n = 1) 1 patient with leak treated with OTSC required percutaneous drainage of the fluid collection |
1 | LAGB | 37 | 0/1 | 15 months | Abdominal pain, band site infection |
| Niland/2017 | RS (14) |
Prior therapies: surgical revision (4), APC (11) Concomitant therapy (1) |
14 | GB | 46–67 | 3/11 | 0–38 years (mean: 9.4 years) | Abdominal pan (7), nausea/vomiting (6), weight gain (2), heartburn (2) |
| Keren/2015 | RS (26) |
OTSC (19/26) Other (7/26): stent (6), plastic biliary prosthesis (1), argon cautery (1), biologic glue (1) |
19 | SG | 21–60 | 9/10 | 3–21 days | Septic shock (1), tachycardia (3), fever (6), pain (5), collection (3), none/routine contrast study (4) |
| Law/2015 | RS (47) | Different etiology, bariatric surgery (10) (8 GB) | 8 | GB | NA | NA | NA | NA |
| Moon/2015 | RS (15) |
Conservative treatment: 8 (then stent in 6, surgery in 3) Endoscopic treatment: 5 (fibrin glue in 3, hemoclips in 2) Clips used also as second therapy in failures |
2 | SG | 22–55 | 2/13 | Early leak (1–6 weeks) | Nausea, pain, fever |
| Mercky/2014 | RS (30) |
Different etiology, bariatric surgery: 19/30 (18 SG, 1 GB) Treatment: OTSC (15/19); OTSC + SEMS: (3/19), OTSC + SEMS + clips + glue (1/19) |
15 |
SG GB |
25–59 | 6/13 |
Early fistulas: 5 (7–20 days) Chronic fistulas: 14 (50–1100 days) |
NA |
| Surace/2011 | RS (19) | Bariatric surgery: 12 (11 SG, 1 GB) | 12 |
SG GB |
NA | NA | NA | NA |
| Bhardway/2010 | RS (8) | All fistulas treated with clips and APC | 8 | GB | 22–66 | 0/8 |
< 1 year: 2 5–15 years: 6 |
Weight regain (5), nausea (3), vomiting (2), pain (1) |
n number, CR case report, RS retrospective, OTCS over-the-scope clip, SG sleeve gastrectomy, GB gastric banding, SEMS self-expandable metal stent, APC argon plasma coagulation, NA data not available