Endoscopic Clip as a Treatment for Gastric Leak After Laparoscopic Sleeve Gastrectomy

Gideon Sroka, MD, MSc, Ori Eyal, MD, Tova Raynes, MD, Dean Keren, MD, Ibrahim Matter, MD

Department of General Surgery and Gastroenterology, Bnai-Zion Medical Center, Haifa, Israel.

Introduction: laparoscopic sleeve gastrectomy (LSG) is becoming the procedure of choice for many bariatric patients. Gastric leak from the staple line is a very challenging complication, and calls for multi-modal treatment. Over the scope clips were originally designed to close gastrotomies in NOTES. We present here our experience with over the scope clips for fistula closure in patients with gastric leak after LSG.

Methods: retrospective data collection of all patients who went through clip placement in our institution between June 2010 and May 2012 due to gastric leaks. Data is presented as mean±SD.

Results: 2 males and 6 females, went through the procedure. Their initial BMI was 41.7±2.9. Leak was diagnosed 15.6±9.5 days after LSG. 6 of the patients were operated urgently, 2 went through CT guided drainage. Clip was placed 35.3±22.7 days after LSG. leak stopped completely after 59±21 days. After follow up of 20.4±10 months all patients have no residual leak, and express an overall satisfaction of 8.3±1.6 on a 1 to 10 scale.

Conclusion: Over the scope clip placement for staple line leak after LSG is becoming a viable treatment option for patients with continued leak and suitable endoscopic findings. Short term results are promising. There is a need for multi-center data accumulation and long term follow up in order to characterize leaks that are suitable for this treatment.

Session: Poster Presentation

Program Number: ETP030