Status of bariatric endoscopy–what does the surgeon need to know? A review

Table 2 Endoscopic drainage techniques for the treatment of leaks and fistulas after bariatric surgery

Endoscopic technique	Indications/advantages	Not indicated/disadvantages	Our experience
Septotomy	(1) You must do it when a septum is identified; (2) Early, late and chronic; (3) High efficacy: 80%-100%; and (4) Safe	It is just performed when a septum is identified!	(1) Very high clinical success rates; and (2) Septum is the cause of most late and chronic leaks/fistulas treated in a center without experience
EVT	(1) Acute, early, late and chronic; (2) High efficacy (> 90%) in leaks with or without associated collection; (3) No need of external drainage; and (4) Superior to stent in upper GI tract	(1) Patient discomfort related to NGT; (2) Usually repeat procedures are needed (sponge); (3) Respiratory/Cutaneous fistula; (4) Longer hospital stay (?); and (5) High costs (?)	(1) Very high clinical success rates; (2) Modified EVT: Easy placement, reduction in procedure time and need for repeat procedures, lower costs and Aes; and (3) Modified trelumina EVT: Drainage and nutrition with one tube through the nares
DPS	(1) Acute, early, late and chronic; (2) High efficacy (> 85%) in leaks/fistulas with associated collection; (3) Easy placement (7fr-gastroscope); (4) No need of external drainage; and (5) Short hospital stay	(1) Longer period for complete healing; (2) Risk of migration and bleeding; (3) No place to accommodate the stent in small collections; and (4) Usually fluoroscopy is needed	(1) Very high clinical success rates; (2) Shorter hospital stay; (3) Faster oral intake (clear liquids); and (4) Better patient acceptance–no symptoms

EVT: Endoscopic vacuum therapy; DPS: Double-pigtails stents; SAE: Severe adverse events; Aes: Adverse events.