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Gastric leakage after sleeve gastrectomy is reported in up to 9% of cases [1]. Endoscopic measures to manage such complications include insertion of self-expandablemetal stents, and application of endoclips or over-the-scope clips [1]. Interventional cardiologists use specialist Amplatzer Occluders (St. Jude Medical, Plymouth, Minnesota, United States) for closure of patent foramen ovale, atrial septal defects, or ventricular septal defects (VSDs) [2]. The Amplatzer Occluder is a self-expandable double-disc device made from a nitinol wire mesh. Dacron polyester patches are sewn into eachdisc and the connecting waist in order to enhance endocardialization of the device. The device was specifically designed for the muscular VSD, and features a neck that is 5–10mm in length, commensurate with the defect, and a slightly larger retention disc on the distal (left) side. This report describes the use of such a device to close a complex gastric leak after bariatric surgery. A 40-year-old morbidly obese man (body mass index 47.6kg/m2, noninsulin-dependent diabetes, arterial hypertension, and obstructive sleep apnea syndrome) underwent gastric sleeve resection in July 2012. A proximal leakage was treated on postoperative Day 7 by endoluminal stent graft application and re-laparoscopic switch to gastric-bypass with Roux Yanastomosis. However, even prolonged stent graft application (including repetitive exchange and endoscopic re-evaluaFig.1 Radiological images during deployment of the ventricular septal defect (VSD) occluder. a The endoscope tip is seen within the gastric leak, and extraluminal paragastric contrast agent is visible. b Placement of a guidewire through the gastric wall into the paragastric space to guide application of the VSD occluder. c Image after deployment of the occluder, showing luminal and extraluminal discs with neck in between. Cases and Techniques Library (CTL) E487

Use of a cardiac occluder for closure of a complex gastric leak after bariatric surgery