Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach
Received 7 July 2009; received in revised form 26 January 2010; accepted 5 February 2010. published online 22 February 2010.
Abstract
Background
Gastrogastric fistulas (GGFs) are a well-known complication of Roux-en-Y gastric bypass. Surgical repair of such fistulas is technically difficult, with significant associated morbidity. The aim of the present study was to evaluate the efficacy of endoscopic GGF closure at a university hospital in the United States.
Methods
Patients with Roux-en-Y gastric bypass and confirmed GGFs on esophagogastroduodenoscopy or barium study. Endoscopic repair was performed with the EndoCinch suturing system (group 1) or clips (group 2). All patients were followed up in the outpatient clinic or interviewed by telephone at 1, 6, and 18 months after the procedure, then as indicated by symptoms.
Results
A total of 95 patients were included in the present series (group 1, n = 71, 75%; group 2, n = 24, 25%). The mean GGF size was significantly larger in group 1 than in group 2 (14.5 ± 8.7 versus 7.7 ± 6, P = .01). An average of 2.2 sutures or 3 clips (range 2–7) was used. Complete initial GGF closure was achieved in 90 patients (95%), with reopening in 59 (65%) an average of 177 ± 202 days. The average follow-up was 395 ± 49 days, with 22 patients lost to follow-up. Two significant complications were reported (bleeding and an esophageal tear). None of the GGFs with an initial size >20 mm remained closed during the follow-up period compared with 10 (32%) of the 31 fistulas ≤10 mm in diameter remained closed.
Conclusion
Peroral endoscopic repair of postbariatric GGFs is technically feasible and safe but with limited durability. The fistula size predicted for long-term outcomes, with the best results seen in fistulas ≤10 mm in diameter.
aDivision of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
bDepartment of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
Reprint requests: Christopher C. Thompson, M.D., M.Sc., F.A.C.G., F.A.S.G.E., Developmental Endoscopy, Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
G. Fernandez-Esparrach was supported by a grant from Generalitat de Catalunya (AGAUR, BE-100022).
G. Fernandez-Esparrach is currently at Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
ABSTRACT