Severe events related to use of stents in bariatric surgical complications

Introduction: Endoscopic self-expandable stents are emerging as safe and effective options for the treatment of bariatric surgery complications. Our aim is to report 3 cases of severe complications after self-expandable stent implantation. Case Description: A retrospective database analysis showed 14 major complications over the past 400 bariatric procedures (3.5%); 8 of them were managed conservatively. Three cases of unusual severe complications after self-expandable stent implantation were observed. In case 1 (leak after resleeving), the self-expandable stent migrated twice and caused an esophageal stenosis, which was treated by endoscopic dilation. Three months later, the stenosis recurred and the patient was a candidate for distal esophagectomy. In case 2 (gastrojejunal stricture after Roux-en-Y gastric bypass), the endoscopic dilation was complicated by perforation and treated with a self-expandable stent. The patient required an emergency laparoscopy to remove the stent that had migrated into the ileum. After 1 month, gastrojejunal stenosis recurred and the patient underwent laparoscopic revision of the anastomosis. In case 3 (leak after vertical banded gastroplasty [VBG]–Roux-en-Y gastric bypass conversion), the self-expandable stent migrated twice and caused an esophageal-pleural fistula managed with a new stent. Discussion: Bariatric surgeons have to balance the possible advantages of self-expandable stents on a case-by-case basis. Complications of endoscopic stents can be life-threatening and are underestimated and under-reported in the literature