Journal of Obesity and Bariatrics
Research Article
Endoscopic Management of Sleeve Gastrectomy Leaks: Outcomes of SEMS and Non-Stented Strategies in a Single Tertiary Center
Nesreen K1, El Matbouly M2*, Bashah M1 and AL-Kuwari M1
1Bariatric and Metabolic Center, Hamad Medical Corporation, Doha, Qatar
2Department of Surgery, Hamad Medical Corporation, Doha, Qatar
2Department of Surgery, Hamad Medical Corporation, Doha, Qatar
*Address for Correspondence:Moamena El Matbouly, Department of Surgery, Hamad Medical
Corporation Ahmed Bin Alit Street, P.O. Box 3050, Doha, Qatar. E-mail Id: momenaelmatbouly@gmail.com
Submission:25 May, 2026
Accepted: 13 June, 2026
Published:16 June, 2026
Copyright: © 2026 Nesreen K, et al. This is an open access
article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is
properly cited.
Keywords: Gastrectomy, Sleeve; Anastomotic Leak; Endoscopy; Stents; Negative-
Pressure Wound Therapy; Bariatric Surgery
Abstract
Background: Staple-line leaks following laparoscopic sleeve gastrectomy (LSG)
cause substantial morbidity. Endoscopic options include self-expandable metal stents
(SEMS), drainage with or without endoscopic closure, and endoluminal vacuum therapy
(E‑VAC).
Methods: We performed a retrospective cohort study of adults with imaging confirmed post-LSG leaks treated at a tertiary bariatric center (2018–2023). Index management was SEMS (± fixation) or non-stented care (antibiotics, percutaneous/ endoscopic drainage, ± endoscopic closure). E‑VAC was reserved as rescue after stent removal or failure of non-stented therapy. Primary outcomes were leak closure and time to healing.
Results: Fifty-seven patients were included; 23 received SEMS and 34 received non-stented care. Overall leak resolution occurred in 53/57 (93.0%). Closure was achieved in 22/23 SEMS patients (95.7%) and 31/34 non-stented patients (91.2%). Mean time to healing was 10.5 weeks in the SEMS group and 8.6 weeks in the nonstented group. Stent-related adverse events occurred in 6/23 (26.1%) SEMS patients and were managed with repositioning, exchange, or planned removal. E-VAC rescue therapy was used in 9 patients; all achieved leak closure (9/9, 100%), with closure documented over 4-8 weeks (mean 5.7 weeks; median 5 weeks).
Conclusions: Both SEMS-based and non-stented strategies achieved high closure in selected patients. We propose a pragmatic, goal-oriented pathway that aligns initial therapy with leak complexity and reserves E‑VAC strictly as rescue; prospective validation is needed.
Methods: We performed a retrospective cohort study of adults with imaging confirmed post-LSG leaks treated at a tertiary bariatric center (2018–2023). Index management was SEMS (± fixation) or non-stented care (antibiotics, percutaneous/ endoscopic drainage, ± endoscopic closure). E‑VAC was reserved as rescue after stent removal or failure of non-stented therapy. Primary outcomes were leak closure and time to healing.
Results: Fifty-seven patients were included; 23 received SEMS and 34 received non-stented care. Overall leak resolution occurred in 53/57 (93.0%). Closure was achieved in 22/23 SEMS patients (95.7%) and 31/34 non-stented patients (91.2%). Mean time to healing was 10.5 weeks in the SEMS group and 8.6 weeks in the nonstented group. Stent-related adverse events occurred in 6/23 (26.1%) SEMS patients and were managed with repositioning, exchange, or planned removal. E-VAC rescue therapy was used in 9 patients; all achieved leak closure (9/9, 100%), with closure documented over 4-8 weeks (mean 5.7 weeks; median 5 weeks).
Conclusions: Both SEMS-based and non-stented strategies achieved high closure in selected patients. We propose a pragmatic, goal-oriented pathway that aligns initial therapy with leak complexity and reserves E‑VAC strictly as rescue; prospective validation is needed.