Endoscopic treatment of gastrointestinal leaks

Abstract

Gastrointestinal leaks are severe complications after bariatric surgery, mainly related to postoperative anastomotic defects with substantial morbidity and mortality. Surgical interventions can be complicated with high morbidity and mortality. Surgical drainage can be indicated when there is peritonitis or perigastric abscess. Conservative management can be an option in stable cases with functioning and correctly located drain. Endoscopy is becoming the first line in treating fistulas due to the endoscopic arsenal for closing and covering the leaks and draining collections; this arsenal includes clips and self-expanding metallic prostheses, tissue sealants, in addition to pigtail and negative pressure therapy. Treatment requires an individualized and multidisciplinary approach. Patient clinical stability, defect chronicity, defect characteristics, and resource availability are essential aspects to consider before the treatment. Endoscopy is a tool that allows direct analysis of the leak orifice and visualization of complications such as strictures. This treatment can be individualized, always considering the endoscopist experience, hospital conditions, and available accessories.