Endoscopic internal drainage for the management of leak, fistula and collection after sleeve gastrectomy: our experience in 617 consecutive patients

Abstract Background Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. Objective to evaluate the efficacy and safety of Endoscopic Internal Drainage (EID) for the management of leak, fistula and collection following SG. Setting Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. Methods EID was used as first line treatment for the management of leaks, fistulae and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with EUS-guided deployment of DPS or lumen apposing metal stents . Results 617 patients (83,3% Female, mean age 43.1 yrs) were enrolled in the study for leak (n=300 – 48.6%), fistula (n=285 – 46.2%) and collection (n=32 – 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5% and 90% for leak, fistula and collection respectively. 10/547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755) and previous endoscopic treatment (OR 4.818). Conclusions Early EID for the management of leak, fistula and post-operative collection after SG seems a safe and effective first-line approach with good long term results.