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BACKGROUND: Fistula, leakage, and stricture formation after bariatric surgery are associated with substantial early and late morbidity. We evaluated the efficacy of endoluminal stent therapy as definitive management.METHODS: A retrospective review was performed from 2001 to October 2010 from a single institution including all patients treated with stent placement after bariatric surgery. We collected age, sex, body mass index (BMI), time from operation to onset of symptoms, number of endoscopies needed, stent-related complications, and long term follow up.RESULTS: 22 patients (17 females/5 males, mean age 51; range 36-71 years) were treated with stents; 16 had gastric bypass, 5 duodenal switch, and one gastric band. Eleven of these operations were revisional bariatric surgery. 20 patients presented from their primary bariatric operation to our institution with a mean of 386 days (range of 11-1875 days). The main indications were: Fistulas- 4 gastrocutaneous and 1 esophagopleural, and Strictures- 16 gastrojejunal and 1 duodeno-ileal (s/p duodenal switch). Eight patients had undergone multiple endoscopic dilations at outside institutions and one stent placement prior to our evaluation. A total of 89 endoscopies were performed (range: 2 to 9 per patient). Mean duration of endoscopic treatment was 125 days (range: 17-367 days). All patients had covered metal stents placed. Stent migration occurred in 10 patients, 3 of whom required operative removal, from the colon, small bowel and Roux limb. Two patients died at home with ongoing symptoms after stent removal. Of the remaining 20 patients, 13 patients required revisional surgery. 2 patients at last hospital visit had return of symptoms and will undergo revisional surgery. In 5 patients stent placement seems to have been effective definitive treatment with a mean follow up of 280 days (range 127-475 days); 2 had closure of a chronic gastrocutaneous fistula (success 2 of 5), but only 3 of 17 patients had resolution of a chronic anastomotic stricture.CONCLUSIONS: Endoscopic therapy provides a less invasive approach and in selected patients may warrant attempt as definitive therapy. Although successful in only 5 of 22 patients (22%), stent placement relieves symptoms and allows resumption of adequate oral nutrition. Stents appear more successful for fistulas rather than anastomotic strictures. If unsuccessful, revisionary surgery will be necessary.