FULL-THICKNESS ENDOSCOPIC STRICTUROTOMY IN THE MANAGEMENT OF SLEEVE GASTRECTOMY STENOSIS ASSOCIATED WITH A COMPLEX FISTULA

Post-laparoscopic sleeve gastrectomy (LSG) leaks and fistulas are the most feared complication of the procedure. Despite technical advancements, leaks and fistulas incidence remain significant – affecting 1.9 to 5.3% of patients after LSG, occurring mainly at the Angle of His level. Endoscopy is now considered the first approach for stable patients, and a combination of therapies is usually required. In addition to treating the defect, it is crucial to address associated factors.
This video presents a case illustrating the treatment of a complex fistula post-LSG through innovative endoscopic methods. Additionally, the case involves sleeve stenosis, effectively managed with endoscopic full-thickness tunneled stricturotomy—a five-step technique including stenosis identification, submucosal injection and incision, submucosal tunneling, full-thickness stricturotomy, and mucosal closure. This procedure emerges as a surgical alternative for patients unresponsive to traditional endoscopic interventions.