Leaks after sleeve gastrectomy are serious postoperative adverse events with significant morbidity. The timing of presentation and the chronicity of the leak affect manage- ment strategy, with acute/early (<6 weeks) leaks typically treated differently from late/chronic (>6-12 weeks) leaks. Ultimately, once a leak has matured and contains a fibrous septum, a septotomy may be necessary for definitive treat- ment. We present our approach to a refractory gastric sleeve leak managed with various endoscopic modalities.
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