Gastric fistula is a severe complication after sleeve gastrectomy, with an incidence ranging from 0.5% to 5.3% . Endoscopic pigtail drain placement has emerged as a minimally invasive alternative for managing these fistula This study investigated the clinical outcomes of endoscopic pigtail drain placement for the management of gastric fistulas following sleeve gastrectomy.

This prospective interventional study was performed using data from patients who underwent pigtail drain placement. Both descriptive and inferential statistical analyses were conducted to evaluate fistula closure rates, incidence of complications, healing time, need for additional interventions, and recurrence rates

The study cohort comprised 30 patients with a mean age of 34.9 ± 9.15 years, ranging from 17 to 51 years. The mean body mass index (BMI) was 38.3 ± 4.1 kg/m², with individual values ranging from 29 to 43 kg/m. one-third of the patients (10/30, 33.3%) had no significant comorbidities. Non-alcoholic fatty liver disease (NAFLD) was present in 8 patients (26.7%), while diabetes mellitus (DM) was observed in 7 patients (23.3%). A combination of NAFLD and DM was identified in 2 patients (6.7%), and a more complex comorbidity profile including DM, hypertension (HTN), and NAFLD was seen in 2 patients (6.7%). Additionally, one patient (3.3%) had both DM and NAFLD. The majority of gastric fistulas were located in the upper region, with 27 patients (86.66%) presenting with fistulas confined to this area. Three patients (10.0%) had fistulas extending from the upper to the middle portion of the stomach. The mean fistula size was 9.4 ± 2.7 mm, with a median size of 10 mm and a range of 5 to 16 mm. leakage occurred in only 6.67% of patients, corresponding to two fistulas located in the upper and middle regions, both of which had a size greater than 15 mm. The readmission rate was approximately 20%,

Endoscopic pigtail catheter placement is a safe and effective minimally invasive option for managing gastric fistulas after sleeve gastrectomy. In our study, the procedure achieved high rates of fistula closure with few complications, even in patients with metabolic comorbidities such as diabetes and non-alcoholic fatty liver disease. Smaller fistulas in the upper portion of the stomach responded particularly well, highlighting the importance of fistula characteristics in guiding treatment. Although higher BMI was modestly associated with longer closure times, it was not a strong predictor on its own. In contrast, the duration of pigtail drain placement showed a strong correlation with healing time, reflecting fistula complexity and the need for careful individualized follow-up. Overall, these findings support early endoscopic pigtail drainage as a first-line approach, promoting faster recovery, shorter hospital stays, and reducing the need for surgical intervention