title: Endoscopic closure of persistent gastric leak and fistula following laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Conservative management for gastric leak and fistulae after laparoscopic sleeve gastrectomy (LSG) often results in prolonged hospitalization as well as requirement of TPN or recurrent surgery (Casella et al., 2009) [1]. Endoscopically-placed stents are an additional non-invasive method, but are associated with the complication of stent migration in up to 50% of cases (Casella and co-workers, 2009) [1,4]. As other non-invasive means of treatment are absent, we believe this case demonstrates a new technique for multiple gastric leaks following LSG in patients without sepsis or peritonitis.
  
  
  METHODS
  A patient developed a staple line gastric leak that persisted for 10 weeks following LSG despite multiple modalities of treatment. She refused to undergo stent placement, so via esophagogastroduodenoscopy (EGD), fistula margins were cauterized with argon plasma coagulation and a fibrin sealant was injected to include the surrounding area. Endoclips were placed along the fistula tracts. A repeat procedure was required. Follow up imaging confirmed resolution of gastric leak and patient did not experience additional complications.
  
  
  CONCLUSIONS
  The patient was able to discontinue TPN and return to an oral diet. Both procedures were well tolerated and did not require hospitalization.
  
  
  CONCLUSIONS
  Endoscopic management of multiple gastric leaks and fistulae using fibrin seal, endoclips, and cauterization appears to be a promising noninvasive form of treatment with a lower associated morbidity and shortened hospitalization.
authors.affiliation: Wake Forest Baptist Medical Center Blvd., Winston-Salem, NC 27157, USA.
authors.forename: Adolfo Z
authors.initials: AZ
authors.lastname: Fernandez
authors.affiliation: Wake Forest Baptist Medical Center Blvd., Winston-Salem, NC 27157, USA. Electronic address: jluthra@wakehealth.edu.
authors.forename: Anjuli K
authors.initials: AK
authors.lastname: Luthra
authors.affiliation: Wake Forest Baptist Medical Center Blvd., Winston-Salem, NC 27157, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Evans
keywords: Endoclips; Endoscopic closure; Gastric bypass; Gastric leak; Laparoscopic sleeve gastrectomy