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Background and Study Aims: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity in treating morbid obesity. Prior studies showed a 3.5% risk of gastric sleeve stenosis (GSS). There is no consensus on how to treat these patients, and the role of endoscopic therapy has been addressed in only a few studies. We aim to assess the efficacy and safety of endoscopic stenting in the management of GSS following LSG., Patients and Methods: Retrospective data were reviewed from July 2009 to November 2013. Patients were referred for endoscopic therapy for symptoms or imaging findings suggestive of gastric leak or narrowing following LSG. Endoscopic therapy included the use of fully covered self-expanding esophageal metal stents (FCSEMS) in addition to over-the-scope clip system (OTSC) when necessary., Results: All 27 patients were females with mean age of 40 years; six patients were excluded from the study. Major symptom was nausea and vomiting in 57% of the patients. Five of 21 patients had concomitant leaks. All 21 patients underwent FCSEMS placement, and four out of five patients (80%) with concomitant leak had OTSC. The success rate in both groups for resolution of stricture and leak was 100%, and no surgical intervention was required. There were no immediate or delayed complications of endoscopic therapy. Median follow-up of 6 months was available for 20/21 patients. Among patients with gastric leak, 80% had resolution of their symptoms compared with 93% of patients with GSS., Conclusions: Endoscopic therapy for LSG-related GSS or leaks with FCSEMS is highly effective and safe.

A consensus concerning the incidence, course and distribution of the posterior gastric artery (PGA) has yet to be reached. Recent literature has explored and subsequently demonstrated the importance of the identification of this vessel in surgical procedures such as subtotal gastrectomy, splenectomy and pancreatic transplantation. The gross anatomy of the PGA was examined in 120 adult human cadavers. The PGA was identified as that artery which provided the predominant arterial supply to the posterior wall of the superior portion of the gastric body near the cardiac region and fundus. A PGA was identified in 81.6% of specimens. The most common origin of the PGA was from the left gastric artery (type I), occurring in 41.8% of specimens. In decreasing order of prevalence, were origins from the splenic artery (Type II), occurring in 25.5%; from both the left gastric and splenic arteries as double PGAs (Type III) in 22.4%; and from the celiac trunk (Type IV) occurring in 10.2%. The importance of accurate delineation of the PGA is crucial for pancreatic transplantation and gastric tumor removal. In addition, knowledge of variations in this vessel's origin could prove useful in transcatheter arterial embolization for the treatment of chronic bleeding from gastric ulcers. Furthermore, ligation of this vessel during partial gastrectomy, pancreaticoduodenectomy, and parietal cell vagotomy may result in gastric wall necrosis and gastric stump leak.