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10.3390/diagnostics16030431
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Review

Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management

by
Jacopo Fanizza
1,
Salvatore Lavalle
2,3,
Edoardo Masiello
4,
Francesco Vito Mandarino
5,6,
Gabriele Altieri
5,6,
Angelo Bruni
7,
Francesco Azzolini
5,
Stefano Olmi
6,8,
Giovanni Carlo Cesana
6,8,
Marco Anselmino
9,
Lorenzo Fuccio
7,
Antonio Facciorusso
10,11,
Armando Dell’Anna
10,11,
Mattia Brigida
10,11,
Vito Annese
1,5,
Silvio Danese
5,6,
Sara Massironi
5,6,
Gianfranco Donatelli
12,13,† and
Giuseppe Dell’Anna
1,6,*,†
1
Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
2
Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy
3
Radiology Unit, Umberto I Hospital, 94100 Enna, Italy
4
Radiology Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
5
Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
6
Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
7
Gastroenterology Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, 40100 Bologna, Italy
8
Department of General and Mini-Invasive Surgery, Policlinico San Marco, 24040 Zingonia, Italy
9
Bariatric Surgery Unit, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
10
Gastroenterology Unit, Faculty of Medicine and Surgery, University of Salento, Piazza Tancredi 7, 73100 Lecce, Italy
11
Digestive Endoscopy Unit, “Vito Fazzi” Hospital, Piazza Filippo Muratore 5, 73100 Lecce, Italy
12
Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy
13
Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, 75013 Paris, France
 
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*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Diagnostics 2026, 16(3), 431; https://doi.org/10.3390/diagnostics16030431
Submission received: 17 December 2025 / Revised: 23 January 2026 / Accepted: 26 January 2026 / Published: 1 February 2026
(This article belongs to the Special Issue Advances in the Diagnostic Imaging of Gastrointestinal Diseases)
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Abstract

Bariatric surgery is an effective treatment for morbid obesity but is frequently complicated by anastomotic leaks, fistulas, and strictures, which can significantly impair patient outcomes. Optimal management of these complications relies on a timely and accurate diagnostic assessment; however, effective treatment strategies are central to improving clinical recovery. This review primarily focuses on the endoscopic management of post-bariatric surgery complications, while providing a concise overview of the diagnostic imaging modalities that guide therapeutic decision-making. Contrast-enhanced imaging techniques, including computed tomography (CT) and fluoroscopy, as well as endoscopic ultrasound (EUS), are briefly discussed in relation to their role in identifying complications, defining their extent, and selecting the most appropriate endoscopic intervention. The core of this review is dedicated to current endoscopic treatment approaches, including endoscopic internal drainage with double pigtail plastic stents, self-expanding metal stents (SEMSs), endoscopic vacuum therapy (EVT), and EUS-guided drainage of fluid collections. Particular emphasis is placed on indications, technical considerations, and outcomes of these therapies. Finally, this review highlights emerging endoscopic technologies that may further optimize the management of post-bariatric surgery complications and improve patient outcomes, underscoring the evolving role of minimally invasive endoscopic treatment within a multidisciplinary framework.
Keywords: bariatric surgery; sleeve gastrectomy; leak; stricture; fistula; endoscopic vacuum therapy; SEMS; EVT; endoscopic internal drainage bariatric surgery; sleeve gastrectomy; leak; stricture; fistula; endoscopic vacuum therapy; SEMS; EVT; endoscopic internal drainage

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MDPI and ACS Style

Fanizza, J.; Lavalle, S.; Masiello, E.; Mandarino, F.V.; Altieri, G.; Bruni, A.; Azzolini, F.; Olmi, S.; Cesana, G.C.; Anselmino, M.; et al. Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management. Diagnostics 2026, 16, 431. https://doi.org/10.3390/diagnostics16030431

AMA Style

Fanizza J, Lavalle S, Masiello E, Mandarino FV, Altieri G, Bruni A, Azzolini F, Olmi S, Cesana GC, Anselmino M, et al. Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management. Diagnostics. 2026; 16(3):431. https://doi.org/10.3390/diagnostics16030431

Chicago/Turabian Style

Fanizza, Jacopo, Salvatore Lavalle, Edoardo Masiello, Francesco Vito Mandarino, Gabriele Altieri, Angelo Bruni, Francesco Azzolini, Stefano Olmi, Giovanni Carlo Cesana, Marco Anselmino, and et al. 2026. "Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management" Diagnostics 16, no. 3: 431. https://doi.org/10.3390/diagnostics16030431

APA Style

Fanizza, J., Lavalle, S., Masiello, E., Mandarino, F. V., Altieri, G., Bruni, A., Azzolini, F., Olmi, S., Cesana, G. C., Anselmino, M., Fuccio, L., Facciorusso, A., Dell’Anna, A., Brigida, M., Annese, V., Danese, S., Massironi, S., Donatelli, G., & Dell’Anna, G. (2026). Endoscopic Management of Post-Bariatric Surgery Complications: Diagnostic Work-Up and Innovative Approaches for Leak, Fistula, and Stricture Management. Diagnostics, 16(3), 431. https://doi.org/10.3390/diagnostics16030431

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