Success Rate of Endoscopic Treatment for Post-Sleeve Gastrectomy Leaks: A Systematic Review and Meta-Analysis.

BACKGROUND

Sleeve gastrectomy (SG) is effective for obesity treatment but can lead to complications like postoperative leaks and fistulas. Endoscopic interventions have become the preferred method of management due to their minimally invasive nature. This meta-analysis evaluates the success rates and complications of various endoscopic treatments for leaks post-SG.

METHODS

A systematic review and meta-analysis following PRISMA 2020 guidelines included 58 studies with 18,685 patients. The databases searched included Scopus, Embase, PubMed, Google Scholar, Web of Science, and Cochrane from inception until February 2025 using related keywords based on search strategy. Data on demographics, intervention types, success rates, and complications were analyzed using R software.

RESULTS

Among 18,685 patients, 2896 developed postoperative leaks. The overall success rate of endoscopic interventions was 88% (95% CI: 85-91.1%; p < 0.0001). Stenting was the most common intervention (48.02%) with a success rate of 90.6% (95% CI: 87.7-93.6%). Endoscopic suturing had the highest success rate (91%; 95% CI: 78.2-100%), followed by endoscopic vacuum therapy (85.1%; 95% CI: 69.4-100%), internal drainage (84.5%; 95% CI: 81.6-87.6%), and over-the-scope clips (77.1%; 95% CI: 55.9-98.2%). The most common complications were stent migration (24.5%) and stenosis (5%). Sensitivity analyses confirmed robust results with no significant publication bias (p = 0.6335).

CONCLUSION

Endoscopic interventions are effective for managing postoperative leaks after sleeve gastrectomy. Stenting and suturing have the highest success rates, though complications like stent migration require attention.