Endoscopic Treatment of Staple-Line Leaks After Sleeve Gastrectomy in Patients with Obesity: Which One is the Best Option, if Any? A Systematic Review with Meta-Analysis and Meta-regression

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery, with staple-line leak (SLL) as its most severe complication. Various endoscopic treatments exist, but no universal algorithm is established. The aim of this paper is to estimate the success rates of different endoscopic techniques for SLL management. A search of Medline, Embase, and SCOPUS identified studies on endoscopic treatments. Pooled success rates were calculated using random-effects modeling. Seventy-nine studies (2205 patients) showed an overall success rate of 84.1%. Double-pigtail drainage (90.07%), endoscopic vacuum therapy (90.2%), and septotomy (88.25%) were most effective. Meta-regression indicated significantly higher success with double-pigtail drainage (p = 0.035). Endoscopic treatments, especially double-pigtail drainage and vacuum therapy, are highly effective for SLL. Further research is needed to compare techniques and evaluate additional clinical factors.