Percutaneous endoscopic vacuum therapy for treatment of severe gastric staple line dehiscence after surgical bypass revision.

Background and Aims: Gastric leaks and gastrocutaneous fistulas (GCFs) are severe adverse events of gastric bypass surgery, often difficult to manage with conventional treatments. Methods: We present the case of a 63-year-old woman who, after revisional surgery for a gastrogastric fistula and weight regain after initial gastric bypass, developed gastric staple line dehiscence and 2 GCFs. Results: Initial endoscopic vacuum therapy using a nasogastric tube was unsuccessful because of patient discomfort. Subsequently, percutaneous endoscopic vacuum therapy (P-EVT) was performed by placing multiple foam devices through the GCFs under endoscopic and fluoroscopic guidance. Weekly tube exchanges were conducted with endoscopic guidance and later percutaneously. The perigastric cavity resolved, and after P-EVT removal, an esophageal stent was placed to facilitate GCF closure. Conclusions: P-EVT represents a novel, less-invasive approach for managing complex gastric leaks, enabling the use of larger and multiple sponges, less-invasive tube exchanges, and a reduced need for frequent endoscopy, thereby enhancing patient comfort and treatment efficacy.