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

Endoscopy retrospective · n=61 · Aug 2, 2026 · Dig Dis Sci · IF 2.5

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

New evidencebariatric endoscopyendoscopy qualityhemostasis

Clinical takeawayConsider an algorithmic approach to endoscopic treatment of post-bariatric leaks, selecting modalities based on clinical condition, timing, and fistula characteristics. Be aware of procedure-related complications (19.7%) and prioritize early intervention for leaks without self-limited cavities, as these were associated with failure (p=0.009).

What it foundEndoscopic treatment of post-bariatric surgery leaks achieved 90.2% success (55/61 patients), with 60% managed by a single modality (stent, OTSC, internal drainage, septal occluder, or septotomy) and 40% requiring combined techniques. The algorithm used considered clinical condition, timing of presentation, and fistula characteristics.

ContextConfirms endoscopic management as first-line for post-bariatric leaks but provides a structured, multimodal algorithm where prior practice was not standardized. Identifies self-limited cavities as a risk factor for failure and internal drainage as linked to longer treatment.

Refinessuggested applicable standard· American Society for Metabolic and Bariatric Surgery (ASMBS), "American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass" (Altieri et al., Surgery for Obesity and Related Diseases), 2023

Decision at stakeendoscopic treatment as first-line for post-bariatric surgery leaks

Diagnose and manage GI complications by bariatric procedure type: post-sleeve GERD with PPI, lifestyle, and conversion to RYGB if refractory; marginal ulcer with high-dose PPI BID plus sucralfate, NSAID avoidance, smoking cessation, and H. pylori test/treat; suspected internal hernia with acute post-RYGB SBO with urgent surgical exploration, using CT to support the diagnosis when it will not delay surgery, a normal CT does not exclude internal hernia, and exploration should proceed when clinical suspicion remains high despite negative imaging; and dumping syndrome with dietary modification (plus acarbose or octreotide for refractory late hypoglycemia). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Diagnose and manage GI complications by bariatric procedure type: post-sleeve GERD with PPI, lifestyle, and conversion to RYGB if refractory; marginal ulcer with high-dose PPI BID plus sucralfate, NSAID avoidance, smoking cessation, and H. pylori test/treat; suspected internal hernia with acute post-RYGB SBO with urgent surgical exploration, using CT to support the diagnosis when it will not delay surgery, a normal CT does not exclude internal hernia, and exploration should proceed when clinical suspicion remains high despite negative imaging; and dumping syndrome with dietary modification (plus acarbose or octreotide for refractory late hypoglycemia). Maintain lifelong nutritional surveillance with annual labs and periodic bone density, and evaluate weight regain multidisciplinarily with endoscopic or surgical revision options.

American Society for Metabolic and Bariatric Surgery (ASMBS), "American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass" (Altieri et al., Surgery for Obesity and Related Diseases), 2023 · reviewed 2026-07-23 ↗

Ödemiş B, Kenarlı K · Digestive Diseases and Sciences · IF 2.5 · PubMed ↗Permalink