Closure of a persistent gastric leak using a cardiac septal occluder.

Anastomotic leaks occur in up to 5% of patients who undergo bariatric surgical procedures [1]. Reoperation is associated with a high morbidity, and a mortality of up to 10% [2]. Therefore, endoscopic management should be considered in the first instance. We present a case of a gastric anastomotic leak that was successfully closed with a cardiac septal occluder device (Amplatzer; St. Jude Medical, Plymouth, Minnesota, USA). A 50-year-old woman was admitted with tachycardia, fever, and vomiting 4 weeks after laparoscopic vertical sleeve gastrectomy. Abdominal computed tomography revealed a 6-cm collection lateral to the gastroesophageal junction. Percutaneous drain insertion did not result in clinical improvement. Esophagogastroduodenoscopy (EGD) revealed a 6×4-mm leak immediately distal to the gastroesophageal junction along the staple line (●" Fig.1). Over-the-scope clip placement (Ovesco Endoscopy AG, Tübingen, Germany), fully-covered selfexpandable esophageal stent insertion, and endoluminal suturing (Overstitch, Apollo Endosurgery, Austin, Texas, USA) all failed to achieve closure. Therefore, closure was pursued using the cardiac septal occluder. The device is a self-expandable double umbrella-shaped Fig.3 Deployment of the cardiac septal occluder. a Fluoroscopic image during deployment of the cardiac septal occluder. The previously placed over-the-scope clip remains. b Endoscopic view of the occluder device after deployment. Fig.2 The Amplazter cardiac septal occluder device.