Successful Endoscopic Vacuum Therapy for a Postoperative Esophagogastric Fistula Following Sleeve Gastrectomy: A Case Report.

Esophagogastric fistulas are a rare but serious complication after sleeve gastrectomy. Their management remains a clinical challenge, especially when conventional endoscopic approaches, such as stent placement, fail. We report the case of a 49-year-old female with a history of hypothyroidism, major depressive disorder, body mass index greater than 50 kg/m², significant smoking history, and obstructive sleep apnea, who developed acute abdominal pain and bleeding after laparoscopic sleeve gastrectomy. She was referred to our institution in hypovolemic shock and underwent exploratory laparotomy with abdominal packing. An upper endoscopy revealed a 5-10 mm esophagogastric leak initially managed with a covered self-expanding stent, which subsequently migrated. The persistent fistula was confirmed by contrast study, and endoscopic negative pressure therapy (endoscopic vacuum-assisted closure (EndoVAC)) was initiated using a polyurethane sponge with scheduled replacements. After six sessions, complete fistula closure was achieved, confirmed by endoscopic and radiographic evaluation. This case highlights the successful use of EndoVAC therapy as a minimally invasive and effective option for managing refractory post-bariatric esophagogastric fistulas. Early consideration of this technique may improve outcomes in similar scenarios.