• Endoscopic treatment
• Endoscopy
• Fistula
• Upper GI
• Upper gastrointestinal

• Esophageal Fistula/diagnostic imaging
• Esophageal Fistula/surgery
• Gastric Fistula/diagnostic imaging
• Gastric Fistula/surgery
• Humans
• Drainage
• Endoscopy, Gastrointestinal/methods
• Upper Gastrointestinal Tract/diagnostic imaging

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

• Endoscopy
• Surgery
• Bariatric
• Gastrointestinal
• Fistulas
• Leaks

• Humans
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Fistula/complications
• Fistula/surgery
• Endoscopy/adverse effects
• Endoscopy/methods
• Bariatric Surgery/adverse effects
• Drainage/adverse effects
• Retrospective Studies
• Treatment Outcome

• Bariatric surgery
• Bleeding
• Fistula
• Gastrojejunal ulceration
• Leak
• Revision obesity surgery endoluminal
• Roux-en-Y gastric bypass
• Sleeve gastrectomy
• Stricture
• Transoral outlet reduction
• Weight regain

• Anastomotic Leak/etiology
• Bariatric Surgery/adverse effects
• Humans
• Obesity, Morbid/surgery
• Retrospective Studies
• Weight Gain

• anastomotic leak
• fistula
• gastrointestinal perforation
• wound closure technique

With the improvement in flexible endoscopic technology and the availability of new endoscopic devices, current endoscopic therapies spare many patients who would otherwise undergo surgical repair of gastrointestinal fistulas. These endoscopic techniques include gastrointestinal stents, endoscopic suturing, cardiac septal occluders, endo-sponge, vacuum therapy and others. This review elaborates on the indications, evidence, procedural details, efficacy, and complications of various endoscopic techniques for the management of gastrointestinal fistulas.

• Gastrointestinal fistula
• endoscopy
• leak
• stent
• suturing
• technique

• Bariatric surgery
• Case report
• Obesity
• Peritonitis
• Weight loss

Gastrointestinal stromal tumors (GISTs) originate from interstitial cells of Cajal. GISTs can occur anywhere along the gastrointestinal tract. Large lesions have traditionally been removed surgically. However, with recent innovations in advanced endoscopy, GISTs located within the stomach are now removed endoscopically. We describe a new innovative endoscopic technique to close large and hard to access defects after endoscopic full-thickness resection of gastric GISTs.

We present a series of three patients who were diagnosed with a gastric GIST. All patients underwent full-thickness endoscopic resection. In all cases, for closure of the surgical bed, conventional endoscopic techniques including hemoclips, endoloop and suturing were unsuccessful. We performed a new technique in which we pulled omental fat into the gastric lumen and completely closed the defect using endoscopic devices. All patients performed well post-procedure and computed tomography was carried out one day after the procedures which showed no extravasation of contrast.

The omental plug technique may be used as an alternative to surgery in selected cases of gastric perforation.

• Gastric perforation
• Gastrointestinal stromal tumors
• Gastric tumor
• Surgery
• Endoscopy
• Suturing

A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a first-line approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects.

• Gastrointestinal
• Endoscopy
• Endoscopic vacuum therapy
• Negative pressure therapy
• Fistula
• Leak
• Perforation
• Defect

The most effective and durable treatment for obesity is bariatric surgery. However, less than 2% of eligible patients who fulfill the criteria for bariatric surgery undergo the procedure. As a result, there is a drive to develop less invasive therapies to combat obesity. Endoscopic bariatric therapies (EBT) for weight loss are important since they are more effective than pharmacological treatments and lifestyle changes and present lower adverse event rates compared to bariatric surgery. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive EBT that involves remodeling of the greater curvature. ESG demonstrated favorable outcomes in several centers, with up to 20.9% total body weight loss and 60.4% excess weight loss (EWL) on 2-year follow-up, with a low rate of severe adverse events (SAE). As such, it could be considered safe and effective in light of ASGE/ASMBS thresholds of > 25% EWL and ≤ 5% SAE, although there are no comparative trials to support this. Additionally, ESG showed improvement in diabetes mellitus type 2, hypertension, and other obesity-related comorbidities. As this procedure continues to develop there are several areas that can be addressed to improve outcomes, including device improvements, technique standardization, patient selection, personalized medicine, combination therapies, and training standardization. In this editorial we discuss the origins of the ESG, current data, and future developments.

• Endoscopy
• Surgery
• Bariatric
• Obesity
• Overweight
• Comorbidities
• Gastroplasty
• Sleeve
• Endoscopic sleeve gastroplasty
• Editorial