Treatment of Leaks and Other Bariatric Complications with Endoluminal Stents

Weight loss surgery is the most effective treatment for morbid obesity we have today. However, gastric bypass surgery is associated with an anastomotic complication rate up to 6% including leaks, fistula formation, and strictures. These complications can be potentially severe, accounting for sepsis and death. Traditional treatment of anastomotic leaks has been surgical with source control and drainage at the leak site. Patients are without oral intake for a variable length of time, and nutrition is provided by either distal enteral feeding if tolerated or by parenteral nutrition that carry their own intrinsic co-morbidities. Strictures often times require multiple dilations and sometimes even surgical revision of the anastomosis which can be very challenging. Revisional surgery for anastomotic leaks or fistulas is time consuming and associated with considerable morbidity. Gonzalez et al. reported a striking overall morbidity of 53% and mortality of 10% including recurrent strictures (13%) and gastrogastric fistulas (10%). With that background in mind, there is the need for a less invasive treatment modality of these potentially disastrous complications.