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

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.