Post-bariatric anastomotic leaks are serious complication following sleeve gastrectomy or gastric bypass procedures. Traditional management often requires surgical reintervention, but endoscopic techniques, particularly the use of self-expanding metal stents (SEMS), offer a minimally invasive alternative. This retrospective study evaluates the efficacy of endoscopic management of post-bariatric fistulas including the use of a double layer stent (Niti-S™ Beta™ Esophageal Stent), focusing on resolution rates, complications, and the number of procedures required for successful resolution.

We retrospectively reviewed patients who developed an anastomotic leak following bariatric surgery between 2014 and 2023. These patients were treated endoscopically with the placement of a double layer stent (Niti-S™ Beta™ Esophageal Stent). The primary endpoint was resolution of the fistula considered achieved when the patient healed without requiring surgical reintervention. Secondary outcomes included adverse events, number of procedures required to achieve fistula resolution and late recurrence. 

Data from 20 patients were collected (17 sleeve gastrectomy, 3 gastric bypass). Effective leak/fistula closure was obtained in 18/20 patients (90%) who achieved resolution of the fistula without the need for subsequent surgical intervention. The mean number of procedures required for resolution was 3 while mean stent indwell time was 26.5 days.”. Adverse events occurred in 3 patients: 1) stent migration, 1) esophageal perforation and 1) esophageal stenosis. All the adverse events were managed endoscopically respectively with 1) stent retrieval and double pig tail stents placement 2) closure with over the scope clip 3) mechanical esophageal dilations.

Regarding long-term outcomes, the mean follow-up duration was 39.3 months. A recurrence of the fistula occurred in 1 patient at 24 months post-treatment. The recurrence was also managed endoscopically. There were no further complications or recurrences during the follow-up period.

Endoscopic management of post-bariatric anastomotic leaks using double layer stents (Niti-S™ Beta™ Esophageal Stent) is a safe and effective approach, with a high-resolution rate (90%) and a reasonable complication rate (15%) in our population. The mean follow-up of 39.3 months demonstrated long-term success, with only a single recurrence managed without surgery. The low need for additional surgical interventions and the ability to manage complications endoscopically further emphasize the value of double layer stents in the management of post-bariatric fistulas. These findings suggest that these stents could be considered as first-line treatment for anastomotic leaks after bariatric surgery, offering a non-invasive alternative with favourable long-term outcomes.