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Endoscopic Closure of Gastric Leak Following Sleeve Gastrectomy in a Pediatric Patient

Troendle, David M.; Qureshi, Faisal

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Journal of Pediatric Gastroenterology and Nutrition: September 2017 - Volume 65 - Issue 3 - p e68
doi: 10.1097/MPG.0000000000001560

An obese 15-year-old boy had undergone sleeve gastrectomy with no immediate complications. He was admitted to an outside institution with progressive vomiting, pain, and fever on postoperative day 25. Cross-sectional imaging demonstrated a fluid collection adjacent to the remnant stomach, which was subsequently drained percutaneously. An upper gastrointestinal series with water soluble contrast demonstrated a leak arising from the left superolateral gastric margin and a stenosis within the gastric remnant (Fig. 1). Conservative measures were attempted for 1 week with no improvement. Endoscopic evaluation was performed on postoperative day 47. A small fistulous tract was identified at the cephalad aspect of the gastric staple line. The lumen of the residual stomach was difficult to identify but provided no resistance to passage of a 9-mm endoscope suggestive of a functional narrowing within the gastric remnant. The pyloric opening was dilated using a 20 mm through the scope balloon and the gastric remnant was dilated with a 30-mm achalasia pneumatic dilation balloon. Next an over the scope clip (Ovesco Endoscopy USA, Inc, Cary, NC) was applied to the gastric leak site (Fig. 2). An upper gastrointestinal series was repeated the second postprocedural day and demonstrated no residual leak and improved forward flow of contrast through the gastric remnant (Fig. 3). His drain output resolved, his diet was advanced, and he was subsequently discharged on the 7th postprocedural day. At 1-month follow-up, his repeat imaging demonstrated no further leak. He had resumed a normal diet as well as his previous activities. See Supplement Digital Content, Video, http://links.lww.com/MPG/A935, for a video summary of this case.

FIGURE 1
FIGURE 1:
Upper gastrointestinal series demonstrating gastric leak (red arrows) and stenosis within gastric remnant (white arrows) before intervention.
FIGURE 2
FIGURE 2:
Fluoroscopic image demonstrating positioning of over the scope clip device.
FIGURE 3
FIGURE 3:
Upper gastrointestinal series demonstrating resolution of gastric leak after placement of over the scope clip device.

Supplemental Digital Content

Copyright © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition