Background

Endoscopic Sleeve Gastroplasty (ESG) is a new and promising endoscopic bariatric procedure. Even it is a minimally invasive procedure, it is not exempted of potential severe complications. Case Report. A 33 years old lady with no relevant past medical history with a BMI of 38kg/m2 underwent a ESG in a private center. 18 hours after the procedure she consulted at the Emergency Room for severe abdominal pain and fever. Abdominal examination showed generalized tenderness. CT scan was requested and reported a gastric perforation. Emergency laparoscopy was indicated and a generalized peritonitis with a perforation of the anterior wall of the stomach was found. Some of the stitches of the ESG were attached to the anterior abdominal wall and the perforation was found between those stitches. The stomach was desestructurated and a simple stitch or a conversion to Sleeve Gastrectomy were not considered safe procedures at that time. Patient was stable and a conversion into Roux-n-Y-Gastric bypass was indicated. The excluded stomach with the perforation was resected. The patient had an uneventful postoperatory and was discharged on POD 7. She is doing well and 12 months after the procedure her BMI is 28kg/m2 with good quality of life and no complications.