Self-Expanding Stents in the Management of Post- Bariatric Surgery Leaks: Is There Still a Role?

Leaks represent one of the most feared complications following bariatric surgery, with an incidence ranging from 1–6%, particularly after sleeve gastrectomy (SG). Endoscopic therapy has largely replaced surgical reintervention, and self-expanding metal stents (SEMS) have traditionally been the first-line treatment. Data from multiple series and meta-analyses confirm high success rates in acute and early leaks, approaching 90–95%. However, efficacy significantly decreases in chronic leaks and fistulas, where success rates may fall below 40%. In parallel, novel endoscopic techniques-including endoscopic vacuum therapy (EVT), endoscopic internal drainage (EID), and over-the-scope clips (OTSC)-have emerged as promising alternatives. This short communication reviews current evidence summarizes the advantages and limitations of SEMS and highlights the need for a stepwise and multidisciplinary approach.