Bariatric surgery is the most effective treatment for the medical comorbidities associated with
morbid obesity. Though uncommon, staple line or
anastomotic leaks after
bariatric surgery are highly morbid events and challenging to treat. In selected patients without
severe sepsis or distant pollution, endoscopic transluminal peritoneal drainage may provide source control. For leaks within 3 days of surgery, endoscopic stenting does not appear to speed closure but does permit oral nutrition. In uncomplicated situations, the risk of migration and resulting complications of enteric
stents appear to overshadow the benefits. Initial treatment failures and leaks presenting more than 48 hours after surgery respond to enteric diversion by endoscopic stenting. Occlusion of the leak by injection of
fibrin glue also shows promise; however, these case series are limited to a small number of patients. Endoclips may work best to occlude leaks and close
fistulas if the epithelium is debrided. As suturing technology improves, direct internal closure of
fistulas may prove feasible. Therapeutic endoscopy offers several technologies that can assist in the closure of early leaks and that are essential to the treatment of late leaks and
fistulas after
bariatric surgery.