Management of Gastric Leaks After Bariatric Surgery: Proposed Endoscopic Treatment Algorithm Based on 10-Year Experience.

BACKGROUND

Endoscopic treatment is the first-line approach for post-bariatric surgery leaks, but treatment algorithms are not standardized. This study aimed to evaluate the outcomes of an endoscopic treatment algorithm and to identify factors associated with clinical success and treatment duration.

METHODS

This retrospective study was conducted on 61 consecutive patients who underwent endoscopic treatment for post-bariatric surgery leaks between 2014 and 2024. Main endoscopic modalities included bariatric stents, over-the-scope clips (OTSC), cardiac septal occluder devices, endoscopic internal drainage and septotomy. The endoscopic treatment modality to be applied was determined with an algorithmic approach according to clinical condition, timing of presentation and fistula characteristics.

RESULTS

Endoscopic treatment was successful in 55 patients (90.2%). Of these, 33 (60%) were managed with a single modality: 14 with bariatric stent, 9 with OTSC, 6 with internal drainage, 3 with cardiac septal occluders, and 1 with septotomy. The remaining 22 patients (40%) required a combination of techniques. Procedure-related complications occurred in 12 patients (19.7%). Endoscopic intervention had failed in six (9.8%) patients. Unsuccessful cases had significantly larger self-limited cavity sizes (p = 0.009). The number of endoscopic sessions and treatment duration was positively correlated with self-limited cavity presence (r = 0.482, p < 0.001 and r = 0.352, p = 0.008) and use of internal drainage (r = 0.477, p < 0.001 and r = 0.479, p < 0.001).

CONCLUSIONS

Endoscopic management of post-bariatric surgery leaks using an institutional multimodal treatment algorithm achieved high clinical success rates. Self-limited cavities were associated with treatment failure, whereas internal drainage was linked to prolonged treatment duration.