Abstract
Background and study aims Staple-line leaks occur in 1 % – 7 % of patients who undergo sleeve gastrectomy,
and can be challenging to treat. The success of endoscopic approaches decreases as
leaks develop into chronic sinus tracts. Endoscopic septotomy has been used to facilitate
healing of refractory leaks by incision and enlargement of the tract to allow direct
communication with the gastric lumen and internal drainage.
Patients and methods We reviewed the technique and outcomes among patients who underwent endoscopic septotomy
at two centers for the management of sleeve gastrectomy-associated gastric fistulas
and perigastric collections refractory to occlusive endoscopic therapies.
Results Nine patients underwent endoscopic septotomy at a mean of 8.6 weeks after leak diagnosis,
following failure of percutaneous and conventional endoscopic modalities. Perigastric
collections ranged from 3 cm to 10 cm in size. The mean procedure time for endoscopic
septotomy was 87.2 minutes. Multiple endoscopic septotomy procedures (mean 2.3, range
1 – 4) were required to achieve radiological resolution. The mean follow-up period
was 21.2 weeks, and all nine patients achieved symptom resolution without the need
for surgery. Bleeding at the time of endoscopic septotomy occurred in three patients,
and was managed with endoscopic clips and did not require transfusion. No other adverse
events or delayed complications were recorded.
Conclusions Endoscopic septotomy appears to be a safe and effective technique for the management
of sleeve gastrectomy-associated fistulae and collections, including those refractory
to other endoscopic and percutaneous methods.
