Background Endoscopic stents are successful in the management
of surgical leaks; however, stent migration remains a
significant problem. In this study, we present our approach
depending on a large bariatrics-specific stent (Mega stent)
and over-the-scope clips in the management of post-bariatric
surgery leaks.
Methods A retrospective analysis of all patients with postbariatric
surgery leaks treated at our institution using an approach
reliant on Mega stents and over-the-scope clips was
conducted. Potential factors associated with procedure success
and occurrence of complications were also evaluated.
Results A total of 81 stents were inserted in 62 patients with
post-bariatric surgery leaks, 46 sleeve gastrectomies (73%)
and 16 Roux-en-Y gastric bypass (27%). Over-the-scope clips
were applied in 29 patients (46%). Leak closure was achieved
in 51 patients (82%). Median number of procedures per patient
was 3 (range 2–8). Complications included the following:
stent migration (11/62, 18%), intolerance necessitating
premature removal (7/62, 11%), esophageal stricture (8/62,
13%), bleeding (4/62, 6%), perforation (4/62, 6%). One
stent-induced mortality was encountered (bleeding). The
presence of open surgery (vs laparoscopic) was significantly
associated with the occurrence of stent-induced complications
(p 0.002).
Conclusion The approach combining Mega stents and overthe-scope
clips is highly effective in the management of postbariatric
surgery leaks and is associated with a low rate of stent
migration and a low number of procedures and stents per
patient. Mega stents, however, should be used with great caution
due to the significant morbidity associated with their use.

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• Large Bariatric-Specific Stents and Over-the-Scope Clips in the Management of Post-Bariatric Surgery Leaks