Leaks following sleeve gastrectomy represent a potentially life-threatening complication associated with significant morbidity. Endoscopic management is continuously evolving, with the X-Tack system (Endoscopic Helix Tacking System, Boston Scientific) emerging as a novel through-the-scope suturing approach for defect closure. The aim of this study is to present the first Greek case series of endoscopic management of post-sleeve gastrectomy leaks using X-Tack as the sole therapeutic modality, and to evaluate its effectiveness, recovery time, and success rate.

This study included patients from a single center who underwent sleeve gastrectomy for morbid obesity and developed a postoperative leak between April 2024 and the present. The complication was managed exclusively using the X-Tack system, which deploys helical tacks connected by non-absorbable suture around the defect, allowing stable and targeted closure.

Five patients (3 males/2 females) with a mean age of 39.8 years (range: 19–60) were included. The mean postoperative day of endoscopic intervention was day 7 (range: 4–10). Complete (100%) technical closure of the leak was achieved in all cases. Mean endoscopic procedure time was 31.6 minutes (20–40). Clinical improvement was observed in all patients, with gradual reintroduction of oral intake after 2 weeks, no need for re-operation, and a mean hospital stay of 18 days (15–20). Three-month follow-up, including repeat gastroscopy, confirmed sustained closure without recurrence or complications.

The X-Tack system appears to be a safe, effective, and minimally invasive option for the endoscopic management of leaks after sleeve gastrectomy. The encouraging outcomes of this case series support its integration into routine clinical practice.