Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations

Figure 9 Endoscopic vacuum therapy for the treatment of a post bariatric and metabolic surgery leak. A: Leak associated collection after laparoscopic sleeve gastrectomy; B: Intracavitary modified endoscopic vacuum therapy (EVT) placement; C: Traditional (polyurethane) sponge system; D: Homemade modified EVT; E: Triple lumen tube used for intraluminal EVT allowing for drainage and nutrition with one tube through the nares; F: Complete tissue healing showing granulation tissue and no signs of infection after EVT treatment. EVT: Endoscopic vacuum therapy; NGT: Nasogastric tube.