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Erschienen in: Obesity Surgery 1/2019

01.09.2018 | Original Contributions

Endoscopic Closure of Gastro-gastric Fistula After Gastric Bypass: a Technically Feasible Procedure but Associated with Low Success Rate

verfasst von: Catherine Tsai, Ulf Kessler, Rudolf Steffen, Hans Merki, Joerg Zehetner

Erschienen in: Obesity Surgery | Ausgabe 1/2019

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Abstract

Background

Gastro-gastric fistulas (GGF) are reported to be as high as 12% after gastric bypass for treatment of morbid obesity. While different endoscopic methods are described, the management traditionally consists of surgical revision with high associated morbidity. The aim of the study was to assess feasibility, safety and success rate of endoscopic closure using an endoscopic suturing device.

Methods

From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing endoscopic closure of a GGF with the Apollo Overstitch system (Apollo Endosurgery, Austin, Texas, USA). Demographic details, procedure details, and outcome variables were recorded.

Results

A total of six patients (M:F = 5:1) underwent endoscopic fistula closure. Five patients (83.3%) had a prior banded gastric bypass (with subsequent band removal). The median number of prior abdominal surgeries was 3, the mean time from bypass to endoscopic fistula closure was 5 years (range 1.1–10.4). While immediate complete endoscopic fistula closure was possible in 10 of 12 attempts in those six patients (83%), all patients had recurrent (persistent) fistulas at follow-up. After a mean follow-up time of 12 months, 83.3% had further laparoscopic converted to open (n = 2) or laparoscopic (n = 3) revisions with complete fistula closure. One patient is refusing further intervention.

Conclusion

Endoscopic gastro-gastric fistula closure with an endoscopic suturing device is feasible and safe. Unfortunately, due to the nature of gastro-gastric fistulas, permanent successful closure is rare. Therefore, the approach should be reserved for patients in whom a laparoscopic or open surgical attempt is impossible due to prior abdominal revisions.
Literatur
2.
Zurück zum Zitat Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.CrossRefPubMed Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.CrossRefPubMed
3.
Zurück zum Zitat Simpfendorfer CH, Szomstein S, Rosenthal R. Laparoscopic gastric bypass for refractory morbid obesity. Surg Clin North Am. 2005;85:119–27. xCrossRefPubMed Simpfendorfer CH, Szomstein S, Rosenthal R. Laparoscopic gastric bypass for refractory morbid obesity. Surg Clin North Am. 2005;85:119–27. xCrossRefPubMed
4.
Zurück zum Zitat Carrodeguas L, Szomstein S, Soto F, et al. Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1:467–74.CrossRefPubMed Carrodeguas L, Szomstein S, Soto F, et al. Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis. 2005;1:467–74.CrossRefPubMed
5.
Zurück zum Zitat Tucker ON, Szomstein S, Rosenthal RJ. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2007;11:1673–9.CrossRefPubMed Tucker ON, Szomstein S, Rosenthal RJ. Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2007;11:1673–9.CrossRefPubMed
6.
Zurück zum Zitat Cho M, Kaidar-Person O, Szomstein S, et al. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204:617–24.CrossRefPubMed Cho M, Kaidar-Person O, Szomstein S, et al. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204:617–24.CrossRefPubMed
7.
Zurück zum Zitat MacLean LD, Rhode BM, Nohr C, et al. Stomal ulcer after gastric bypass. J Am Coll Surg. 1997;185:1–7.CrossRefPubMed MacLean LD, Rhode BM, Nohr C, et al. Stomal ulcer after gastric bypass. J Am Coll Surg. 1997;185:1–7.CrossRefPubMed
8.
Zurück zum Zitat Corcelles R, Jamal MH, Daigle CR, et al. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11:1227–32.CrossRefPubMed Corcelles R, Jamal MH, Daigle CR, et al. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11:1227–32.CrossRefPubMed
9.
Zurück zum Zitat Papavramidis ST, Eleftheriadis EE, Papavramidis TS, et al. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc. 2004;59:296–300.CrossRefPubMed Papavramidis ST, Eleftheriadis EE, Papavramidis TS, et al. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc. 2004;59:296–300.CrossRefPubMed
10.
Zurück zum Zitat Spaun GO, Martinec DV, Kennedy TJ, et al. Endoscopic closure of gastrogastric fistulas by using a tissue apposition system (with videos). Gastrointest Endosc. 2010;71:606–11.CrossRefPubMed Spaun GO, Martinec DV, Kennedy TJ, et al. Endoscopic closure of gastrogastric fistulas by using a tissue apposition system (with videos). Gastrointest Endosc. 2010;71:606–11.CrossRefPubMed
11.
Zurück zum Zitat Mukewar S, Kumar N, Catalano M, et al. Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study. Endoscopy. 2016;48:1023–8.CrossRefPubMed Mukewar S, Kumar N, Catalano M, et al. Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study. Endoscopy. 2016;48:1023–8.CrossRefPubMed
12.
Zurück zum Zitat Niland B, Brock A. Over-the-scope clip for endoscopic closure of gastrogastric fistulae. Surg Obes Relat Dis. 2017;13:15–20.CrossRefPubMed Niland B, Brock A. Over-the-scope clip for endoscopic closure of gastrogastric fistulae. Surg Obes Relat Dis. 2017;13:15–20.CrossRefPubMed
13.
Zurück zum Zitat Lopez-Nava G, Galvao M, Bautista-Castaño I, et al. Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success. Endosc Int Open. 2016;4:E222–7.CrossRefPubMedPubMedCentral Lopez-Nava G, Galvao M, Bautista-Castaño I, et al. Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success. Endosc Int Open. 2016;4:E222–7.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Cucchi SG, Pories WJ, MacDonald KG, et al. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221:387–91.CrossRefPubMedPubMedCentral Cucchi SG, Pories WJ, MacDonald KG, et al. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221:387–91.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Gumbs AA, Duffy AJ, Bell RL. Management of gastrogastric fistula after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2:117–21.CrossRefPubMed Gumbs AA, Duffy AJ, Bell RL. Management of gastrogastric fistula after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2:117–21.CrossRefPubMed
17.
Zurück zum Zitat Chahine E, Kassir R, Dirani M, et al. Surgical management of gastrogastric fistula after Roux-en-Y Gastric Bypass: 10-year experience. Obes Surg. 2018;28:939–44.CrossRefPubMed Chahine E, Kassir R, Dirani M, et al. Surgical management of gastrogastric fistula after Roux-en-Y Gastric Bypass: 10-year experience. Obes Surg. 2018;28:939–44.CrossRefPubMed
18.
Zurück zum Zitat Felsher J, Farres H, Chand B, et al. Mucosal apposition in endoscopic suturing. Gastrointest Endosc. 2003;58:867–70.CrossRefPubMed Felsher J, Farres H, Chand B, et al. Mucosal apposition in endoscopic suturing. Gastrointest Endosc. 2003;58:867–70.CrossRefPubMed
19.
Zurück zum Zitat Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis. 2010;6:282–8.CrossRefPubMed Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis. 2010;6:282–8.CrossRefPubMed
20.
Zurück zum Zitat Bhardwaj A, Cooney RN, Wehrman A, et al. Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg. 2010;20:1090–5.CrossRefPubMed Bhardwaj A, Cooney RN, Wehrman A, et al. Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg. 2010;20:1090–5.CrossRefPubMed
Metadaten
Titel
Endoscopic Closure of Gastro-gastric Fistula After Gastric Bypass: a Technically Feasible Procedure but Associated with Low Success Rate
verfasst von
Catherine Tsai
Ulf Kessler
Rudolf Steffen
Hans Merki
Joerg Zehetner
Publikationsdatum
01.09.2018
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 1/2019
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3488-1

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